Abstract：
UNASSIGNED: The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their independent predictors.
UNASSIGNED: Retrospective cross-sectional study of women who consented to MTX treatment in 2017-2018 at our institution (N = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols (n = 25). All patients were treated according to our institution\'s protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients\' demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum β-human chorionic gonadotropin (β-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe).
UNASSIGNED: Two ninety-two patients were included in the current analysis. Age, pre-treatment β-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16-4.66, p = .017), no pelvic pain (aOR 2.65, 95%CI 1.03-6.83, p = .043), lower initial β-hCG level (aOR 1.32, 95%CI 1.08-1.59, p = .005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04-153.6; p = .047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase (p = .017), 32% higher for each 1000 IU/L increase in initial β-hCG level (p = .005), and >2 folds higher in presence of pelvic pain (p = .043).
UNASSIGNED: MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment β-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine β-hCG titres where treatment would be ineffective.
Ectopic pregnancy is a pregnancy that occurs outside the uterus. It needs to be identified and treated quickly to prevent serious health complications. Ectopic pregnancies can be treated surgically or medically using a drug called methotrexate. Medical treatment of ectopic pregnancy is not always successful. Identifying the factors that predict the failure of medical treatment helps patients and doctors to choose more accurately between surgical and medical treatment options.A total of 292 women who received methotrexate for ectopic pregnancy and the factors that influence the outcomes of treatment were examined, 39 patients had treatment failure and required surgery. Older age, higher initial levels of β-human chorionic gonadotropin (β-hCG) hormone, the presence of pelvic pain, and foetal cardiac activity had increased risk of treatment failure. In the future, research could consider the relationship between the size of the ectopic pregnancy and the treatment outcomes and refine the β-hCG level cut-off for better treatment effects.
UNASSIGNED: Retrospective cross-sectional study of women who consented to MTX treatment in 2017-2018 at our institution (N = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols (n = 25). All patients were treated according to our institution\'s protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients\' demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum β-human chorionic gonadotropin (β-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe).
UNASSIGNED: Two ninety-two patients were included in the current analysis. Age, pre-treatment β-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16-4.66, p = .017), no pelvic pain (aOR 2.65, 95%CI 1.03-6.83, p = .043), lower initial β-hCG level (aOR 1.32, 95%CI 1.08-1.59, p = .005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04-153.6; p = .047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase (p = .017), 32% higher for each 1000 IU/L increase in initial β-hCG level (p = .005), and >2 folds higher in presence of pelvic pain (p = .043).
UNASSIGNED: MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment β-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine β-hCG titres where treatment would be ineffective.
Ectopic pregnancy is a pregnancy that occurs outside the uterus. It needs to be identified and treated quickly to prevent serious health complications. Ectopic pregnancies can be treated surgically or medically using a drug called methotrexate. Medical treatment of ectopic pregnancy is not always successful. Identifying the factors that predict the failure of medical treatment helps patients and doctors to choose more accurately between surgical and medical treatment options.A total of 292 women who received methotrexate for ectopic pregnancy and the factors that influence the outcomes of treatment were examined, 39 patients had treatment failure and required surgery. Older age, higher initial levels of β-human chorionic gonadotropin (β-hCG) hormone, the presence of pelvic pain, and foetal cardiac activity had increased risk of treatment failure. In the future, research could consider the relationship between the size of the ectopic pregnancy and the treatment outcomes and refine the β-hCG level cut-off for better treatment effects.
摘要：
■患者的治疗前特征和异位妊娠以确定可能对甲氨蝶呤（MTX）治疗成功应答的患者仍存在争议。这项研究调查了一次和两次MTX剂量后异位妊娠的结局及其独立预测因素。
■对2017-2018年在我们机构接受MTX治疗的女性进行回顾性横断面研究（N=317）。其中,剖宫产瘢痕妊娠患者因需要不同的治疗方案而被排除(n=25).所有患者均根据我们机构基于国际指南的方案进行治疗，并在本研究中纳入的三家医院进行标准化。我们检索了病人的人口统计,实验室,超声检查,和我们医院数据库的临床特征。使用电化学发光免疫分析法测量血清β-人绒毛膜促性腺激素（β-hCG）；使用超声检查（经阴道探头）诊断异位妊娠。
■目前的分析中包括了92例患者。年龄,治疗前β-hCG水平，超声检查存在卵黄囊，胎儿心脏活动的存在，结果成功和不成功的患者的盆腔疼痛有显著差异.年轻年龄(调整后的优势比[aOR]2.33，95%置信区间(CI)1.16-4.66，p=0.017)，无盆腔疼痛（aOR2.65，95CI1.03-6.83，p=.043），较低的初始β-hCG水平（aOR1.32，95CI1.08-1.59，p=0.005），和胎儿心脏活动缺失(aOR12.63;95%CI1.04-153.6;p=0.047)与成功独立相关。每增加10岁，治疗失败几率>2倍（p=0.017），初始β-hCG水平每增加1000IU/L，增加32%(p=0.005)，和>2倍以上的骨盆疼痛存在（p=.043）。
■MTX对大多数患者有效，避免侵入性手术，这可能会影响生育能力。治疗前β-hCG水平,年龄,盆腔疼痛,胎儿心脏活动与结局独立相关.研究应评估异位妊娠大小与治疗结果之间的关系，并完善治疗无效的β-hCG滴度。
异位妊娠是发生在子宫外的妊娠。需要快速识别和治疗，以防止严重的健康并发症。异位妊娠可以使用称为甲氨蝶呤的药物进行手术或医学治疗。异位妊娠的药物治疗并不总是成功的。确定预测医疗失败的因素有助于患者和医生更准确地在手术和医疗选择之间进行选择。共有292名接受甲氨蝶呤治疗异位妊娠的妇女进行了检查，并分析了影响治疗结果的因素。39例患者治疗失败，需要手术治疗。年纪大了,β-人绒毛膜促性腺激素（β-hCG）激素的初始水平较高，骨盆疼痛的存在，胎儿心脏活动增加了治疗失败的风险。在未来,研究可以考虑异位妊娠的大小与治疗结局之间的关系,并细化β-hCG水平的临界值,以获得更好的治疗效果.
■对2017-2018年在我们机构接受MTX治疗的女性进行回顾性横断面研究（N=317）。其中,剖宫产瘢痕妊娠患者因需要不同的治疗方案而被排除(n=25).所有患者均根据我们机构基于国际指南的方案进行治疗，并在本研究中纳入的三家医院进行标准化。我们检索了病人的人口统计,实验室,超声检查,和我们医院数据库的临床特征。使用电化学发光免疫分析法测量血清β-人绒毛膜促性腺激素（β-hCG）；使用超声检查（经阴道探头）诊断异位妊娠。
■目前的分析中包括了92例患者。年龄,治疗前β-hCG水平，超声检查存在卵黄囊，胎儿心脏活动的存在，结果成功和不成功的患者的盆腔疼痛有显著差异.年轻年龄(调整后的优势比[aOR]2.33，95%置信区间(CI)1.16-4.66，p=0.017)，无盆腔疼痛（aOR2.65，95CI1.03-6.83，p=.043），较低的初始β-hCG水平（aOR1.32，95CI1.08-1.59，p=0.005），和胎儿心脏活动缺失(aOR12.63;95%CI1.04-153.6;p=0.047)与成功独立相关。每增加10岁，治疗失败几率>2倍（p=0.017），初始β-hCG水平每增加1000IU/L，增加32%(p=0.005)，和>2倍以上的骨盆疼痛存在（p=.043）。
■MTX对大多数患者有效，避免侵入性手术，这可能会影响生育能力。治疗前β-hCG水平,年龄,盆腔疼痛,胎儿心脏活动与结局独立相关.研究应评估异位妊娠大小与治疗结果之间的关系，并完善治疗无效的β-hCG滴度。
异位妊娠是发生在子宫外的妊娠。需要快速识别和治疗，以防止严重的健康并发症。异位妊娠可以使用称为甲氨蝶呤的药物进行手术或医学治疗。异位妊娠的药物治疗并不总是成功的。确定预测医疗失败的因素有助于患者和医生更准确地在手术和医疗选择之间进行选择。共有292名接受甲氨蝶呤治疗异位妊娠的妇女进行了检查，并分析了影响治疗结果的因素。39例患者治疗失败，需要手术治疗。年纪大了,β-人绒毛膜促性腺激素（β-hCG）激素的初始水平较高，骨盆疼痛的存在，胎儿心脏活动增加了治疗失败的风险。在未来,研究可以考虑异位妊娠的大小与治疗结局之间的关系,并细化β-hCG水平的临界值,以获得更好的治疗效果.
