成都中医药大学 硕士学位论文 根据HCG动态曲线分析异位妊娠保守治疗疗效 姓名：方英 申请学位级别：硕士 专业：中医妇科学 指导教师：吴克明 2009-05 成都中医药大学硕士研究生毕业论文 第 I 页 摘 要 目的:探讨宫外孕号方加减联合氨甲喋呤和四氢叶酸保守治疗异位妊娠成 功后，回顾性分析患者血清-HCG 值呈现的不同曲线变化与治愈时间及用药 总疗程数之间的关系，以期在预测治疗时间，保障保守治疗成功和避免过度使 用化疗药物方面加以探索；并比较治疗前后 B 超所示附件区包块的变化情况， 初步分析其与疗效的关系。 方法：选取宫外孕号方加减合氨甲喋呤和四氢叶酸保守治疗异位妊娠， 并取得成功的异位妊娠患者，共 26 例。将患者住院期间测得的血清-HCG 值 分别绘制成动态曲线图，按图形不同特点分为两组：第一组：宫外孕号方加 减合氨甲喋呤和四氢叶酸保守治疗异位妊娠第1疗程结束后测血HCG值上 升超过用药前水平，经第 2 或第 3 疗程后逐渐下降，曲线图中出现波峰，称峰 型曲线，共 10 例。第二组：宫外孕号方加减合氨甲喋呤和四氢叶酸保守治疗 异位妊娠第 1 疗程结束后测血HCG 值曲线呈下降趋势，称下降型曲线，共 16 例。于图中标注出患者每疗程用药起始时间在血HCG 值曲线上的位置， 以及血HCG 峰值、 峰值 50%及 10%的位置。 分别统计患者年龄、 停经天数、 治疗前的血-HCG 值、 血-HCG 峰值、 治疗前和治疗期间 B 超所示附件区包 块的最大剖面积，血-HCG 值下降至峰值 50%及 10%时所各需的治疗天数、 血-HCG 值从 50%下降至 10%所用的治疗天数及治疗总疗程数。治疗期间采 用 B 超动态监测异位妊娠包块的变化，比较治疗前后包块的变化情况。将上述 数据整理制表，对所获两组资料进行统计学分析，找出以上数据与该方法治疗 异位妊娠疗效的关系。 结果：经统计学检验和分析表明，两组患者年龄、停经天数、治疗前的血 -HCG 值、 血-HCG 峰值、 治疗前和治疗期间 B 超所示附件区包块的最大剖 成都中医药大学硕士研究生毕业论文 第 II 页 面积差异无显著性（P0.05） ，两组资料具有可比性；峰型曲线组血HCG 值下降至峰值 50%及 10%时所需的治疗天数、治疗总疗程数均高于下降型曲线 组， 差异有显著性 （P0.05） ； 而两组病例血HCG 值从峰值 50%下降至 10% 的治疗天数差异无显著性（P0.05） 。第 1 组治疗前后 B 超所示附件区包块无 统计学意义，差异无显著性（P0.05） ；第 2 组治疗前后 B 超所示附件区包块 有统计学意义，差异有显著性（P0.05） 。 结论：异位妊娠保守治疗过程中，在第一疗程结束时血-HCG 值变化呈 峰型曲线的患者血-HCG 值下降至峰值 50%及 10%时所需的治疗天数、所用 总疗程数均高于下降型曲线组（P0.05） 。 根据异位妊娠药物保守治疗用药后血-HCG 值的变化情况，可及 时调整治疗方案。通过调整用药剂量，疗程间隔时间等达到既提高治愈率，缩 短治疗时间，又可以避免过度使用化疗药物所带来的毒副反应的目的。 峰型曲线组和下降型曲线组血-HCG值从峰值50%下降至10%的 治疗天数差异无显著性（P0.05） ，故化疗药物应尽量集中在血-HCG 值下降 至峰值 50%之前的治疗前半程，而峰值 50%之后的治疗后半程应以中药治疗为 主。 采用血-HCG 峰值及其 50%、10%值的相关数据作为衡量药物治 疗效果的标准有其不可替代的合理性和优越性。 B 超所示病灶包块大小与治疗效果及血-HCG 值无必然联系，在 临床中只能将 B 超作为辅助监测手段，预判病情的转归，而不能作为疗效判断 的主要指标。 关键词：血-HCG 动态曲线 ；异位妊娠 ；保守治疗 ；疗效 成都中医药大学硕士研究生毕业论文 第 III 页 Abstract Objective:The purpose of this study is to analysis the relation between effect and curing time of different human chorionic gonadotropin curve after methotrexate(MTX),citrovorum factor and Extrauterine Pregnancy II for ectopic pregnancy (EP). Expect to find some kind of therapy method for not only ensuring the success rate of conservative treatment but also avoiding the medicine adverse reaction according to different type of serum beta-hCG changes curve.Comparing Annex B-Mass changes before and after treatment,and preliminarily analysising the relationship with efficacy. Methods:Select 26 patients who were ever hospitalized in the Chengdu University of Traditional Chinese Medicine Affiliated Hospital diagnosed with ectopic pregnancy. They were all treated with therapy of methotrexate(MTX), citrovorum factor and Extrauterine Pregnancy II and successfully cured. Drawing curve chart for every different period beta-hCG during the treated process.Distinguish all the curve chart for two groups,according to their different feature.One is designated humping shape curve.Which are the cases the level of serum beta-hCG taking on the tendency of rising after the 1st course of treatment,and falling off after the 2nd or the 3rd course of treatment. There are 10 cases possess this kind of character in all. The other type is designated descending shape curve.Which are the cases the level of serum beta-hCG taking on the tendency of faling off merely after the 1st. There are 16 cases possess this kind of character in all. Then marking the onset time of every course of treatment for every patient on the curve chart.Marking the location of the peak amplitude of serum beta-hCG,the fig of 50%and 10% of the peak amplitude of beta-hCG. Summarize the patientsages,the days of menolipsis, serum Human 成都中医药大学硕士研究生毕业论文 第 IV 页 chorionic gonadotriopin of admission,the peak amplitude of serum beta-hCG,the maximal post-mortem area of ectopic pregnancy in ultrasonographic appearance during the whole treated process and before the conservative treatment, days which beta-hCG decreased to the fig of 50%and 10%of the peak amplitude of serum beta-hCG,the days of the fig of beta-hCG decreased from 50% to 10% and the total count of course of treatment.During the treatment monitoringing dynamically the mass changes in ectopic pregnancy with B-ultrasound.Comparing Annex B-Mass changes before and after treatment,and preliminarily analysising the relationship with efficacy.Unscrambling the above-mentioned numerical data in datasheet.Comparing and analysising the numerical data of the two groups we got by using statistically method. Result:The comparing and analysising indicate that the ages,the days of menolipsis, serum Human chorionic gonadotriopin of admission,the peak amplitude of serum beta-hCG,the maximal post-mortem area of ectopic pregnancy in ultrasonographic appearance during the whole treated process and before the conservative treatment, for all the patients have no significant discrepancy （P0.05） . The two sets have comparability. The patientsdays which beta-hCG decreased to the fig of 50%and 10%of the peak amplitude of serum beta-hCG,the total count of course of trea