异位妊娠保守治疗后血HCG值动态变化规律研究

发布时间：2018-06-27 20:50

本文选题：异位妊娠保守治疗 + 血HCG变化幅度　；参考：《青海大学》2017年硕士论文

【摘要】：目的:探讨异位妊娠保守治疗后第1d、4d、7d的血HCG值变化与患者治疗最终预后之间的相关性。方法:分析2014年10月至2016年10月期间在青海大学附属医院妇科住院部确诊,并接受甲氨喋呤联合米非司酮片药物保守治疗的异位妊娠疾病的临床病例共111例。按照药物保守治疗的最终预后,将临床病例分为成功组94例,失败组17例。分别观察两组病例在治疗前和药物保守治疗期间血HCG值的变化幅度、所用疗程数以及副反应的发生情况等。结果:本次研究的药物保守治疗的成功率为84.68%。两组患者在治疗前的初始血HCG值水平及治疗后1d、4d、7d的血HCG值水平成功组均低于失败组。不同血HCG值水平分层病例行药物保守治疗的有效率具有差异性。药物保守治疗后第1d血HCG值变化幅度对于预测最终治疗获得成功的灵敏度和特异度依次为94.7%和94.1%,约登指数为0.888,ROC曲线下面积为0.967;药物保守治疗后第4d血HCG值变化幅度对于预测最终疗效获得成功的灵敏度和特异度依次为84.0%和100.0%,约登指数为0.840,ROC曲线下面积为0.956;药物保守治疗后第7d血HCG值变化幅度对于预测患者最终疗效获得成功的灵敏度和特异度依次为90.4%和94.1%,约登指数为0.845,ROC曲线下面积为0.956。结论:EP在药物保守治疗前及治疗后第1d、4d、7d血HCG值含量对治疗的最终结局有预测性。药物保守治疗后第1d、4d、7d的血HCG值的下降幅度(相较于初始血HCG值)对EP治疗的最终结局具有预测性。药物保守治疗后第1d的血HCG值变化幅度对于预测保守治疗获得成功的灵敏度和特异度均优于治疗后第4d和第7d的。保守治疗后第1d的血HCG值下降幅度可在临床上可作为对患者保守治疗成功与否的提前预判,但并不适合作为患者的出院指征;以药物治疗后第7d的血HCG值下降幅度作为评价患者是否可以出院或是继续行第二疗程治疗的指标是可行的。两组患者在药物保守治疗后副反应及所用疗程上不具差异性。
[Abstract]:Objective: to investigate the correlation between the change of serum HCG value and the final prognosis of ectopic pregnancy after conservative treatment. Methods: from October 2014 to October 2016, 111 cases of ectopic pregnancy were diagnosed and treated with methotrexate and mifepristone tablets in the department of gynecology, affiliated hospital of Qinghai University. According to the final prognosis of conservative drug therapy, the clinical cases were divided into success group (94 cases) and failed group (17 cases). The changes of serum HCG, the number of courses of treatment and the occurrence of side effects were observed before treatment and during conservative treatment. Results: the success rate of conservative drug therapy in this study was 84.68%. The level of HCG in both groups was lower than that in the failed group at the first day of treatment and the serum HCG level of the successful group on the 1st day and the 4th day after the treatment, and the level of HCG in the successful group was lower than that in the failed group. The effective rate of conservative drug therapy in patients with different serum HCG levels was different. The sensitivity and specificity of serum HCG on the 1st day after conservative treatment were 94.7% and 94.1%, respectively, and the area under the ROC curve of 0.888g was 0.967.The change of HCG value on the 4th day after conservative treatment was 0.967a. The sensitivity and specificity of the degree to predict the success of the final curative effect were 84.0% and 100.0%, respectively, and the area under the curve was 0.956. The range of changes of serum HCG value on the 7th day after conservative drug therapy was successful for predicting the final curative effect of the patient. The sensitivity and specificity were 90.4% and 94.1%, respectively, and the area under the ROC curve was 0.956. Conclusion the HCG level in blood of 7 days before and 1 day after drug conservative treatment has a predictive effect on the final outcome of the treatment. The decrease of serum HCG value (compared with the initial HCG value) on the 1st day and 4th day after conservative treatment was predictive of the final outcome of EP therapy. The sensitivity and specificity of HCG in predicting the success of conservative therapy were better than those on the 4th and 7th day after conservative therapy. The decrease of HCG value on the 1st day after conservative treatment can be used as an early predictor of the success of conservative treatment, but it is not suitable for the patient to be discharged from hospital. It is feasible to evaluate whether the patients can be discharged from hospital or continue with the second course of treatment with the decrease of serum HCG on the 7th day after drug therapy. There was no difference in side effects and course of treatment between the two groups after conservative drug therapy.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22

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