摘要：Objective: Given the great variability of human chorionic gonadotropin (HCG) levels after a single dose of methotrexate (MTX) for ectopic pregnancy, it remains complicated to identify cases undergoing persistence until a week from treatment. We evaluated whether pretreatment patterns of HCG levels could be useful for an earlier detection of persistent trophoblast. Study design: A retrospective study on 62 patients treated by a systemic single dose of methotrexate (50 mg/m2) for an ectopic pregnancy. Samples for HCG detection were obtained on days -2 and 0 before the therapy, on days +3, +7 and then weekly until values were undetectable. Patients were divided into three groups: Group U (up, meaning "increasing") and Group D (down, meaning "decreasing") when HCG levels on day 0 were respectively higher or lower than day -2 level of more than 20%and Group P (plateau) when the difference between day-2 HCG level and the level on day 0 was less than 20%. Results: All the patients of Group D underwent a complete resolution, with a percentage of 33.3%of cases who underwent an initial rise of HCG levels on day +3. The percentage of cases undergoing an initial rise of HCG levels in Group U patients was significantly higher than in Group P patients (60.0%versus 28.6%), but the resolution rate resulted similar in the two groups. For patients of Group P, an increase of HCG levels on day +3 was significantly correlated to the failure of the therapy. Indeed, comparing the cases with an immediate increase of HCG levels to the cases with immediate decrease of HCG levels on day +3, the persistence rate was 80%for the former and 12%for the latter (P< 0.0001). Conclusion: An initial rise of HCG levels after the therapy does not seem to have a clinical relevance in Group D and Group U patients, it well correlates to trophoblastic persistence in Group P patients.

摘要：Objective: The purpose of this study was to compare success rates of 643 patients who had ectopic pregnancy from the same database who were treated with multidose or single- dose methotrexate protocols. Study design: We compared demographics, gestational age, serum human chorionic gonadotropin, progesterone levels, ectopic sac size and volume, overall ectopic mass size and volume, ectopic cardiac activity, history of ectopic pregnancy, number of treatment days, methotrexate doses, and outcome in consecutive patients with ectopic pregnancy who were treated with methotrexate. Results: Success rates were comparable between patients with multidose and single- dose therapy (95% vs 90% , respectively) as were human chorionic gonadotropin and progesterone levels, history of ectopic pregnancy (21.4% vs 21.7% , respectively), number of treatment days, gestational age, ectopic size, ectopic vo- lume, and ectopic mass volume. Patients who received single- dose therapy were significantly heavier (146 vs 159 pounds), had greater ectopic cardiac activiy(3.1% vs 10.3% ), and received fewer methotrexate doses. Conclusion: This study suggests single- dose methotrexate therapy is as effective as multidose methotrexate therapy for the treatment of ectopic pregnancy.

摘要：目的探讨血药浓度监测在大剂量氨甲蝶呤（MTX）治疗中的应用价值。方法选择各类恶性肿瘤患者22例,随机分成两组,对照组12例,实验组10例;对照组仅凭医师临床经验给药。实验组以实际用药剂量与计算机设计剂量之差在15%以内作为执行计算机设计给药方案的标准。测量受试者第1-4天MTX血药浓度,根据每次测量结果调整下一次MTX的用量,使其血液浓度控制在5×10^-8mol/L以下。结果两组患者第1天共有3例患者MTX血液浓度超过要求值,其中对照组2例,实验组1例;第2天两组均没有变化;第3天对照组有1例超过要求值,实验组则全部符合要求;第4天两组患者均符合要求。结论监测患者血药浓度,依此设计个体给药方案,可有效预防致死毒性的发生。