血绒毛膜促性腺激素β在异位妊娠病情监测中的应用

目的探讨监测绒毛膜促性腺激素-β（human chorionic gonadotropin,β-hCG）在异位妊娠（ectopic pregnancy,EP）病情监测中的应用。方法对123例具有相同保守治疗指征的EP患者,保守治疗前均常规监测β-hCG,间隔48h复测一次。按50mg/m2计算给药,采用甲氨蝶呤（methotrexate,MTX）单次肌肉注射,用药后第4d（96h）再次监测β-hCG下降情况,每周一次,至β-hCG降到正常（β-hCG〈100U/L）。EP保守治疗成功组93例根据β-hCG上升或下降分为A组37例、B组56例,EP保守治疗失败的30例为C组（保守后改手术治疗）。结果三组在年龄、孕龄、EP包块直径大小间比较,无统计学意义（P〉0.05）;第一次测定血的β-hCG值结果A与B组比较无统计学意义（P〉0.05）。间隔48h测定,A组β-hCG有所下降,B组升高,A与B组比较有统计学意义（P〈0.01）。应用MTX治疗后A组β-hCG下降幅度〉15%,B组β-hCG有不同程度的升高,与A组比较差异有统计学意义（P〈0.01）。C组因在观察中改行手术治疗,保守治疗失败未做比较。三组β-hCG降至正常的时间B组较A组长,C组最短,差异有统计学意义（P〈0.01）。结论EP保守治疗前后监测β-hCG值的高低有助于判断治疗效果和时间。

The observation of human serum chorionic gonadotropin-beta in monitoring ectopic pregnancy

Objective To evaluate the application of human serum chorionic gonadotropin - beta （β - hCG） in monitoring ectopic pregnancy （EP）. Methods 123 patients with EP who under the same indications were treated with single- dose of intramuscular methotrexate （MTX） （50mg/m2 ）. Serum level of β- hCG was measured with radioimmunoassay before and 48 hours after intramuscular injection of MTX. β- hCG was monitored weekly till it became normal. 93 patients who were successfully treated with MTX were divided into two groups according to the β- hCG level. Thirty- seven cases in group A whose level of β- hCG were decreased, fifty- six cases in group B whose level of β- hCG were increased and 30 cases in group C （operation were performed after failure of conservation therapy）. Results There were no significant differences in patients age, gestational age, and size of EP mass among group A , B and C （P〉0.05）. There were no significant differences in serum level of β - hCG before methotrexate injected （P〉0. 05） in group A and group B. After 48 hours, the β- hCG level in group A was significantly lower than that in group B （P〈0. 01）. Conclusion Monitoring the level of serum β - hCG before and after MTX used is helpful in the judgment of the therapy effect for EP.