标题：超声在早期未破裂TIP甲氨蝶呤治疗中的指导作用

      作者：邓仝彤，崔智飞，肖四华    郑州大学附属郑州中心医院超声医学科，河南 郑州 450000

      卷次： 2024年35卷14期

      【摘要】 目的 探讨超声检测形态与血流信息定量技术在早期未破裂输卵管间质部妊娠(TIP)甲氨蝶呤(MTX)治疗中的指导作用。方法 回顾性选取2019年2月至2023年11月在郑州大学附属郑州中心医院接受超声引导下局部注射MTX治疗的196例早期未破裂TIP患者作为研究对象，所有患者停经时间均≤60 d，其中161例治疗成功(成功组)，35例治疗失败(失败组)。比较两组患者的临床资料和超声检测结果[超声分型、与宫腔相通、胎心搏动、胎芽、胎芽长、肌层包绕厚度、病灶最大径、收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)]及β-人绒毛膜促性腺激素(β-HCG)水平，采用Pearson法分析超声检测结果与β-HCG的相关性，采用多因素Logistic回归分析MTX治疗结局的独立影响因素，采用受试者工作特征曲线(ROC)分析不同方案预测MTX治疗结局的价值。结果 失败组患者的胚芽长、病灶最大径、PSV、EDV、β-HCG分别为(0.97±0.20) cm、(3.21±0.59) cm、(0.60±0.18) m/s、(0.39±0.11) m/s、(12 431.60±1 725.46) U/L，明显高于成功组的(0.62±0.23) cm、(1.97±0.45) cm、(0.48±0.13) m/s、(0.28±0.09) m/s、(9 326.50±1 589.77) U/L，RI为 0.35±0.10，明显低于成功组的 0.42±0.11，差异均有统计学意义(P<0.05)；胚芽长 (r=0.766)、病灶最大径 (r=0.702)、PSV (r=0.794)、EDV (r=0.835)与 β-HCG 呈正相关 (P<0.05)，RI(r=-0.827)与β-HCG呈负相关(P<0.05)；多因素Logistic回归分析结果显示，胚芽长、病灶最大径、PSV、EDV、RI、β-HCG均是MTX治疗结局的独立相关因素(P<0.05)；经ROC分析结果显示，胚芽长、病灶最大径、PSV、EDV、RI、β-HCG预测MTX治疗失败的曲线下面积(AUC)介于 0.727~0.834，其中β-HCG的AUC为 0.834 (95%CI：0.775~0.883)，且联合预测MTX治疗失败的AUC为0.917 (95%CI：0.869~0.951)，差异有统计学意义(P<0.05)。结论 超声检测胚芽长、病灶最大径、PSV、EDV、RI联合β-HCG对早期未破裂TIP MTX治疗失败具有一定预测价值，并对后续临床决策具有一定指导意义，可作为临床评估MTX治疗结局的有效方案之一。
      【关键词】 超声；血流动力学；输卵管间质部妊娠；甲氨蝶呤；治疗结局；预测
      【中图分类号】 R714.22+1 【文献标识码】 A 【文章编号】 1003—6350（2024）14—2061—06

Guiding role of ultrasound in the treatment of early unruptured TIP with methotrexate.
DENG Tong-tong, CUIZhi-fei, XIAO Si-hua. Department of Ultrasonic Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000, Henan, CHINA
【Abstract】 Objective To investigate the guiding role of ultrasound morphological and blood flow informationquantitative technology in the treatment of early unruptured interstitial tubal pregnancy (TIP) with methotrexate (MTX).Methods A retrospective study was conducted on 196 patients with early unruptured TIP who underwent ultra-sound-guided local injection of MTX at Zhengzhou Central Hospital Affiliated to Zhengzhou University from February2019 to November 2023. All patients had a menstrual cessation time of≤60 days, of which 161 were successfully treat-ed (success group) and 35 were unsuccessfully treated (failure group). The clinical data and ultrasound detection results[ultrasound classification, communication with the uterine cavity, fetal heartbeat, embryonic bud, length of embryonicbud, thickness of muscular wrapping, maximum diameter of lesion, peak systolic velocity (PSV), end diastolic velocity(EDV), resistance index (RI)], and β-human chorionic gonadotropin (β-HCG) levels were compared between the twogroups. The correlation between ultrasound detection results and β-HCG was analyzed using Pearson's method, and theindependent factors affecting the outcome of MTX treatment were analyzed using multivariate logistic regression analy-sis. The value of different schemes for predicting the outcome of MTX treatment was analyzed using the receiver operat-ing characteristic (ROC) curve. Results The length of embryonic bud, maximum diameter of lesion, PSV, EDV, andβ-HCG in the failure group were (0.97±0.20) cm, (3.21±0.59) cm, (0.60±0.18) m/s, (0.39±0.11) m/s, and (12 431.60±1 725.46) U/L, respectively, which were significantly higher than (0.62±0.23) cm, (1.97±0.45) cm, (0.48±0.13) m/s,(0.28±0.09) m/s, and (9 326.50±1 589.77) U/L in the success group, and RI was 0.35±0.10, significantly lower than 0.42±0.11 in the success group, with statistically significant differences (P<0.05). The length of embryonic bud (r=0.766),maximum diameter of lesion (r=0.702), PSV (r=0.794), EDV (r=0.835) were positively correlated with β-HCG (P<0.05), and RI (r=-0.827) was negatively correlated with β-HCG (P<0.05). The results of multivariate logistic regressionanalysis showed that length of embryonic bud, maximum diameter of lesion, PSV, EDV, RI, and β-HCG were indepen-dent factors related to the outcome of MTX treatment (P<0.05). The ROC curve showed that the area under the curve(AUC) of length of embryonic bud, maximum diameter of lesion, PSV, EDV, RI, and β-HCG for predicting MTX treat-ment failure ranged from 0.727 to 0.834, and the AUC of β-HCG was 0.834 (95%CI: 0.775-0.883); the AUC of the com-bination of these factors was 0.917 (95%CI: 0.869-0.951), showing a statistically significant difference with each factoralone (P<0.05). Conclusion Ultrasonic detection of the length of embryonic bud, the maximum diameter of lesion,PSV, EDV, RI, and β-HCG in combination has certain predictive value for MTX treatment failure in patients with earlyunruptured TIP, which has certain guiding significance for subsequent clinical decision-making, and can be used as oneof the effective methods for clinical evaluation of MTX treatment outcomes.
      【Key words】 Ultrasound; Hemodynamics; Tubal interstitial pregnancy; Methotrexate; Treatment outcome; Predict