Therapeutic Evaluation Of Sequential Therapy Of Extrauterine Pregnancy By HCG Dynamic Curve

Background: Extrauterine pregnancy is a hackneyed acuteabdomen of department of gynaecology and obstetrics. For the pastfew years incidence rate of it takes on a ascending tendency.Theincidence rate is about 1.9%~2.5%. In recent years with thedevelopment of the technique for detecting serum and urinebeta-hCG, colpultrasonography and the technique of abdominoscope,more and more patients of ectopic pregnancy are early diagnosised.The requirement of patients are change to early diagnosis earlytherapy and to retain the capability of breeding as far as possible.So conservative treatment by medicine for extrauterine pregnancybecomes one of pinupest methods for patients of ectopic pregnancy.In all the methods ,the mechanism of sequential therapy ofmethotrexate (MTX) and mifepristone is more consistented with themedicine metabolism dynamics and drug effect dynamics. Thepurpose of this study is to analysis the relation bwtween the effectand curing time of different human chorionic gonadotropin curveafter sequential therapy of methotrexate (MTX) and mifepristone(Ru486)for extrauterine pregnancy (EUP).Expect to find somekind of therapy method for not only ensuring the success rate ofconservative treatment but also avoiding the medicine adversereaction according to different type of serum beta-hCG changescurve.Objective: The purpose of this study is to analysis the relationbwtween the effect and curing time of different human chorionicgonadotropin curve after sequential therapy of methotrexate (MTX)and mifepristone(Ru486)for extrauterine pregnancy (EUP).Expectto find some kind of therapy method for not only ensuring thesuccess rate of conservative treatment but also avoiding the medicineadverse reaction according to different type of serum beta-hCGchanges curve.Methods: Select 106 patients who were ever hospitalized inNanshan hospital of Shenzhen diagnose with extrauterine pregnancy(exclude cervical pregnancy). They all treated with sequentialtherapy of methotrexate and mifepristone and successfully cured.Drawing curve chart for every different period beta-hCG during thetreated process.Distinguish all the curve chart for two group,according to their different feature.One is designated humping shapecurve.Which are the cases the level of serum beta-hCG taking on thetendency of rising after the 1st course of treatment,and faling offafter the 2nd or the 3rd course of treatment.There are 40 casespossess this kind of character in all.The other type is designateddescending shape curve.Which are the cases the level of serumbeta-hCG taking on the tendency of faling off merely after the1st.There are 66 cases possess this kind of character in all.Thenmarking the onset time of every course of treatment for every patienton the curve chart.Marking the location of the peak amplitude ofserum beta-hCG,the fig of 50% and 10% of the peak amplitude ofbeta-hCG. Summarize the patients' ages,the days of menolipsis, themaximal diameter of ectopic mass in ultrasonographic appearanceduring the whole treated process,days which beta-hCG decreased tothe 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 thetotal count of course of treatment. Unscrambling theabove-mentioned numerical data in datasheet. Compare and analysisthe numerical data the two groups we got by using statisticallymethod.Result: The comparing and analysising indicate that the ages,thedays of menolipsis, the maximal diameter of ectopic mass inultrasonographic appearance during the whole treated process for allthe patients have no significant discrepancy(P>0.05).The two setshave comparability. Meanwhile all the numerical data consistent withGaussian distribution and homoscedasticity.The patients' days whichbeta-hCG decreased to the fig of 50% and 10% of the peak amplitudeof serum beta-hCG, the total count of course of treatment of the groupof humping shape curve are entirely obviously exceed the patints ofthe group of descending shape curve(P<0.05). The concretednumber are 3.45±1.41days,3.12±2.44 days and 0.60±0.28 coursesof treatment respectively.But the days of the fig of beta-hCGdecreased from 50% to 10% have no significant discrepancy betweenthe two sets(P>0.05).Conclusion: 1. The patients' days which beta-hCG decreased tothe fig of 50% and 10% of the peak amplitude of serum beta-hCG,the total count of course of treatment of the group of humping shapecurve are entirely obviously exceed the patints of the group ofdescending shape curve(P<0.05)in conservative treatment forextrauterine pregnancy;2. We can adjust the treatment plan promptlyaccording to the various tendency of the serum beta-hCG curve. Sowe not only can ensure the success rate of conservative treatment butalso can avoid the medicine adverse reaction and shorten the time oftherapy;3. The days of the fig of beta-hCG decreased from 50% to10% have no significant discrepancy between the two sets(P>0.05).So the therapy measures should be use in proso-half course oftreatment concentrately;4. The standard of selecting pathogeneticcondition for conservative treatment of extrauterine pregnancyshould be released pertinently.Part of cases which have higher fig ofbeta-hCG, appearance of fetal heart beat or comparatively largeectopic mass in ultrasonographic and abdominal pain should not beregard as the contraindications absolutely;5. We use the fig of 50%and 10% of the peak amplitude of serum beta-hCG and correlateddata as standard of the effct of conservative treatment forextrauterine pregnancy.It is rationality and superiority;6. Thesequential therapy of methotrexate and mifepristone for extrauterinepregnancy is a very effective method.Because the mechanism ofaction consistent with the medicine metabolism dynamics.