不同疗程药物保守治疗产后胎盘植入残留宫内的临床效果
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摘要
目的:比较不同疗程甲氨蝶呤联合米非司酮治疗胎盘植入产妇的临床疗效。方法:选取花都区人民医院妇产科2014年9月至2016年3月间收治的胎盘植入产妇104例,采用随机数字法将其分为短疗程组和长疗程组,每组各52例。两组患者均给予脐静脉注射甲氨蝶呤和口服米非司酮治疗,其中短疗程组患者连续治疗1周,长疗程组患者连续治疗4周。比较两组患者的临床疗效、各指标恢复时间及不良反应发生率。结果:两组患者的治愈率均为100.00%;长疗程组患者β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)转阴、血清肌酸激酶(creatine kinase,CK)转阴及肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)转阴及孕酮值转阴的时间均低于短疗程组(P<0.01),长疗程组的胎盘完全清除时间、月经恢复时间及住院时间均低于短疗程组(P<0.01),两组的治疗费用和不良反应发生率比较差异无统计学意义(P>0.05)。结论:增加甲氨蝶呤与米非司酮给药时间,不仅能提高胎盘植入的治疗疗效,且不会增加不良反应和治疗费用,治疗安全性高,值得在临床推广。
Objective:To compare the clinical efficacy of different courses of methotrexate combined with mifepristone in treatment of placenta increta. Methods:104 cases of placenta increta enrolled from September 2014 to March 2016, were randomly divided into the short course group and long course group, 52 cases in each group. The two groups of patients were given umbilical vein injection of methotrexate and oral mifepristone treatment, while patients in the short course group were treated for 1 weeks, and the patients in the long course group were treated for 4 weeks. The clinical efficacy, the recovery time of each index and incidence of adverse reactions in the two groups were compared. Results:The cure rate of the two groups was 100 %. In the long course group, the conversion time of β-human chorionic gonadotropin(β-HCG) negative, creatine kinase(CK) negative, creatine kinase isoenzyme(CK-MB) negative and progesterone negative was significantly lower than that of the short course group(P<0.01). The time of placental complete removal, menstrual recovery and hospitalization in the long course group was all lower than that in the short course group(P<0.01), and the difference in treatment cost and incidence of adverse reactions between the two groups was not statistically significant(P>0.05). Conclusion:Increasing the administration time of methotrexate and mifepristone can not only improve the therapeutic effect of placenta implantation, but also will not increase the adverse reactions and treatment costs. The treatment is safe and worthy of clinical promotion.
Objective:To compare the clinical efficacy of different courses of methotrexate combined with mifepristone in treatment of placenta increta. Methods:104 cases of placenta increta enrolled from September 2014 to March 2016, were randomly divided into the short course group and long course group, 52 cases in each group. The two groups of patients were given umbilical vein injection of methotrexate and oral mifepristone treatment, while patients in the short course group were treated for 1 weeks, and the patients in the long course group were treated for 4 weeks. The clinical efficacy, the recovery time of each index and incidence of adverse reactions in the two groups were compared. Results:The cure rate of the two groups was 100 %. In the long course group, the conversion time of β-human chorionic gonadotropin(β-HCG) negative, creatine kinase(CK) negative, creatine kinase isoenzyme(CK-MB) negative and progesterone negative was significantly lower than that of the short course group(P<0.01). The time of placental complete removal, menstrual recovery and hospitalization in the long course group was all lower than that in the short course group(P<0.01), and the difference in treatment cost and incidence of adverse reactions between the two groups was not statistically significant(P>0.05). Conclusion:Increasing the administration time of methotrexate and mifepristone can not only improve the therapeutic effect of placenta implantation, but also will not increase the adverse reactions and treatment costs. The treatment is safe and worthy of clinical promotion.
引文
[1] 时黔宇. 甲氨蝶呤、米非司酮联合益母调经合剂治疗胎盘粘连植入的疗效[J]. 中国现代医学杂志, 2015, 25(28):106-109.
[2] Shen Y, Liao Y, Feng G, et al. Uterine artery embolization for hemorrhage resulting from second-trimester abortion in women with scarred uterus: report of two cases[J]. International Journal of Clinical & Experimental Medicine, 2015, 8(8):196-202.
[3] Pei HY, Zhang DW, Wu QL, et al. Ectopic pregnance II decoction combined with methotrexate and mifepristone for ectopic pregnancy: A randomized controlled trial[J]. Chinese Journal of Evidence-Based Medicine, 2012, 12(2):168-172.
[4] 王娟, 黄燕萍. 药物保守治疗植入性胎盘的疗效观察[J]. 中国妇幼健康研究, 2013, 24(3):683-684.
[5] Tai WL. Methotrexate combined with mifepristone to methotrexate therapy effect observation of ectopic pregnancy[J]. World Latest Medicine Information, 2015.
[6] Lian QH. Clinical effect of methotrexate combined with mifepristone in the treatment of ectopic pregnancy on different blood beta human chorionic gonadotrophin levels[J]. China Modern Medicine, 2014,10(34):1093-1099.
[7] 徐海英, 沈春映. 不同剂量米非司酮治疗子宫肌瘤的近、远期疗效观察[J].中国药房, 2012,41(24):2229-2230.
[8] 张国琼. 甲氨蝶呤联合米非司酮治疗异位妊娠的作用探讨[J]. 河北医学, 2015,23(8):1439-1441.
[9] Wang G, Liu X, Bi F, et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy[J]. Fertility & Sterility, 2014, 101(5):1501-1507.
[10] 胡瑜凌, 乔林, 杨琳,等. 不同剂量及疗程米非司酮治疗大鼠子宫内膜异位症的疗效[J]. 中华妇幼临床医学杂志:电子版, 2012, 8(6):586-588.
[11] Boggavarapu NR, Berger C, Von GC, et al. Effects of low doses of mifepristone on human embryo implantation process in a three-dimensional human endometrial in vitro co-culture system.[J]. Contraception, 2016, 94(2):143-151.
[12] 刘立群, 何善阳, 游泽山,等. 不同剂量米非司酮联合当归四逆汤在子宫内膜异位症术后治疗中的应用[J]. 广东医学, 2013, 34(6):962-965.
[13] Habal FM, Huang VW. Review article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient[J]. Alimentary Pharmacology & Therapeutics, 2012, 35(5):501-515.
[14] 卢桂珍, 杨莉. 甲氨蝶呤联合米非司酮治疗输卵管妊娠80例[J]. 中国现代医生, 2012, 50(10):62-63.
[15] 白素芳, 刘云婷, 张伟芬. 甲氨蝶呤联合米非司酮治疗异位妊娠临床研究[J]. 海南医学院学报, 2015, 21(12):1661-1663.
[16] Lessey BA, Lebovic DI, Taylor RN. Eutopic endometrium in women with endometriosis: ground zero for the study of implantation defects.[J]. Seminars in Reproductive Medicine, 2013, 31(2):109-124.
[17] 蔺明华. 甲氨蝶呤与米非司酮联合中药保守治疗宫外孕临床分析[J]. 昆明医科大学学报, 2012, 33(8):81-83.
[18] Karasu T, Marczylo TH, Marczylo EL, et al. The effect of mifepristone (RU486) on the endocannabinoid system in human plasma and first-trimester trophoblast of women undergoing termination of pregnancy[J]. Journal of Clinical Endocrinology & Metabolism, 2013, 99(3):871-880.
[19] 徐颖媚, 刘健玲, 向冬梅,等. 甲氨蝶呤或子宫动脉灌注栓塞联合清宫术治疗胎盘植入的效果评价[J]. 中国临床研究, 2015, 28(2):222-224.
[20] Lalitkumar S, Boggavarapu NR, Menezes J, et al. Polyethylene glycated leukemia inhibitory factor antagonist inhibits human blastocyst implantation and triggers apoptosis by down-regulating embryonic AKT[J]. Fertility & Sterility, 2013, 100(4):1160-1169.
[2] Shen Y, Liao Y, Feng G, et al. Uterine artery embolization for hemorrhage resulting from second-trimester abortion in women with scarred uterus: report of two cases[J]. International Journal of Clinical & Experimental Medicine, 2015, 8(8):196-202.
[3] Pei HY, Zhang DW, Wu QL, et al. Ectopic pregnance II decoction combined with methotrexate and mifepristone for ectopic pregnancy: A randomized controlled trial[J]. Chinese Journal of Evidence-Based Medicine, 2012, 12(2):168-172.
[4] 王娟, 黄燕萍. 药物保守治疗植入性胎盘的疗效观察[J]. 中国妇幼健康研究, 2013, 24(3):683-684.
[5] Tai WL. Methotrexate combined with mifepristone to methotrexate therapy effect observation of ectopic pregnancy[J]. World Latest Medicine Information, 2015.
[6] Lian QH. Clinical effect of methotrexate combined with mifepristone in the treatment of ectopic pregnancy on different blood beta human chorionic gonadotrophin levels[J]. China Modern Medicine, 2014,10(34):1093-1099.
[7] 徐海英, 沈春映. 不同剂量米非司酮治疗子宫肌瘤的近、远期疗效观察[J].中国药房, 2012,41(24):2229-2230.
[8] 张国琼. 甲氨蝶呤联合米非司酮治疗异位妊娠的作用探讨[J]. 河北医学, 2015,23(8):1439-1441.
[9] Wang G, Liu X, Bi F, et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy[J]. Fertility & Sterility, 2014, 101(5):1501-1507.
[10] 胡瑜凌, 乔林, 杨琳,等. 不同剂量及疗程米非司酮治疗大鼠子宫内膜异位症的疗效[J]. 中华妇幼临床医学杂志:电子版, 2012, 8(6):586-588.
[11] Boggavarapu NR, Berger C, Von GC, et al. Effects of low doses of mifepristone on human embryo implantation process in a three-dimensional human endometrial in vitro co-culture system.[J]. Contraception, 2016, 94(2):143-151.
[12] 刘立群, 何善阳, 游泽山,等. 不同剂量米非司酮联合当归四逆汤在子宫内膜异位症术后治疗中的应用[J]. 广东医学, 2013, 34(6):962-965.
[13] Habal FM, Huang VW. Review article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient[J]. Alimentary Pharmacology & Therapeutics, 2012, 35(5):501-515.
[14] 卢桂珍, 杨莉. 甲氨蝶呤联合米非司酮治疗输卵管妊娠80例[J]. 中国现代医生, 2012, 50(10):62-63.
[15] 白素芳, 刘云婷, 张伟芬. 甲氨蝶呤联合米非司酮治疗异位妊娠临床研究[J]. 海南医学院学报, 2015, 21(12):1661-1663.
[16] Lessey BA, Lebovic DI, Taylor RN. Eutopic endometrium in women with endometriosis: ground zero for the study of implantation defects.[J]. Seminars in Reproductive Medicine, 2013, 31(2):109-124.
[17] 蔺明华. 甲氨蝶呤与米非司酮联合中药保守治疗宫外孕临床分析[J]. 昆明医科大学学报, 2012, 33(8):81-83.
[18] Karasu T, Marczylo TH, Marczylo EL, et al. The effect of mifepristone (RU486) on the endocannabinoid system in human plasma and first-trimester trophoblast of women undergoing termination of pregnancy[J]. Journal of Clinical Endocrinology & Metabolism, 2013, 99(3):871-880.
[19] 徐颖媚, 刘健玲, 向冬梅,等. 甲氨蝶呤或子宫动脉灌注栓塞联合清宫术治疗胎盘植入的效果评价[J]. 中国临床研究, 2015, 28(2):222-224.
[20] Lalitkumar S, Boggavarapu NR, Menezes J, et al. Polyethylene glycated leukemia inhibitory factor antagonist inhibits human blastocyst implantation and triggers apoptosis by down-regulating embryonic AKT[J]. Fertility & Sterility, 2013, 100(4):1160-1169.