RESUMO
Objective:To investigate the efficacy of methotrexate combined with mifepristone in the treatment of ectopic pregnancy and its effect on serum human chorionic gonadotropin (β-HCG) and cancer antigen 125 (CA125) levels and endometrial thickness.Methods:Eighty-two patients with ectopic pregnancy who received treatment in Ningbo Yinzhou No. 2 Hospital, China from August 2017 to August 2019 were included in this study. They were randomly assigned to receive treatment with methotrexate (control group, n = 41) or methotrexate combined with mifepristone (observation group, n = 41). Clinical efficacy was evaluated, and adverse reactions and clinical recovery indexes were observed in each group. Before and after treatment, serum biochemical indexes, endometrial thickness and mass diameter were compared between the observation and control groups. Results:Clinical efficacy in the observation group was significantly higher than that in the control group [95.12% (39/41) vs. 75.61% (31/41), χ2 = 6.248, P < 0.05]. The incidence of adverse reaction in the observation group was significantly lower than that in the control group [4.88% (2/41) vs. 19.51% (8/41), χ2 = 4.100, P < 0.05]. After treatment, serum β-HCG, CA125, progesterone and vascular endothelial growth factor levels in the control and observation groups were (1 106.26 ± 122.36) U/L and (902.65 ± 61.32) U/L, (32.26 ± 6.86) kU/L and (28.26 ± 5.26) kU/L, (15.33 ± 3.01) nmol/L and (10.33 ± 1.92) nmol/L, (85.36 ± 16.41) ng/L and (65.33 ± 12.22) ng/L, respectively, which were significantly lower than those before treatment ( t = 56.964 and 82.206, 12.380 and 17.642, 9.976 and 19.471, 7.490 and 12.912, all P < 0.05). After treatment, serum β-HCG, CA125, progesterone and vascular endothelial growth factor levels in the observation group were significantly lower than those in the control group ( t = 10.624, 3.304, 8.967, 6.991, all P < 0.05). After treatment, endometrial thickness and mass diameter in the control and observation groups were (8.23 ± 1.81) mm and (6.25 ± 1.25) mm, (2.21 ± 0.52) cm and (1.52 ± 0.35) cm respectively, which were significantly lower than those before treatment ( t = 3.555 and 15.118, 11.631 and 24.167, both P < 0.05). After treatment, endometrial thickness and mass diameter in the observation group were significantly less or smaller than those in the control group ( t = 6.248 and 7.861, both P < 0.05). After treatment, symptom disappearance time, serum β-HCG recovery time, urine β-HCG negative time, pelvic mass disappearance time and hospital stay in the control and observation groups were (7.26 ± 1.92) d and (4.23 ± 0.85) d, (16.25 ± 3.82) d and (12.33 ± 2.21) d, (15.36 ± 3.26) d and (10.66 ± 2.12) d, (24.12 ± 4.12) d and (18.66 ± 3.61) d, (29.58 ± 5.68) d and (23.52 ± 4.36) d, respectively. After treatment, symptom disappearance time, serum β-HCG recovery time, urine β-HCG negative time, pelvic mass disappearance time and hospital stay in the observation group were significantly shorter than those in the control group, respectively ( t = 10.305, 6.343, 8.631, 7.118, 6.044, all P < 0.05). Conclusion:Methotrexate combined with mifepristone is highly effective in the treatment of ectopic pregnancy because it can reduce adverse reactions, decrease serum β-HCG, CA125, progesterone and vascular endothelial growth factor levels, promote the recovery of serum β-HCG to normal level, reduce endometrial thickness, and promote adnexal mass disappearance, which are conducive to the early recovery of patients, with good clinical safety.
RESUMO
Objective To investigate the variance levels of plasma soluble leukocyte differentiation antigens CD40 (sCD40) and soluble CD40 ligand (sCD40L) in preeclamptic patients with renal damage and its relationship. Methods A total of 63 pregnant women attended the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College between August 2008 and June 2010. In the present study included 28 pregnant women with mild preeclampsia and 35 patients with severe preeclampsia. Thirty matched normotensive pregnant women were enrolled in the study as the control group. Expression of sCD40 and sCD40L were determined by ELISA. At the same time, the blood routine, C reaction protein ( CRP),urine routine, 24 hours urine protein excretion, and serum uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN) were measured. The correlation analysis was performed between the sCD40/sCD40L and the blood biochemical indexes in 3 groups. Results ( 1 ) The median levels of CRP in severe preeclampsia (10. 8 mg/L)and mild preeclampsia group(7. I mg/L)are significantly higher than that of control group (3. 3 mg/L,P ＜ 0. 05 ); The level of CRP in severe preeclampsia group was also higher than that of mild preeclampsia group ( P ＜ 0. 05 ). The median gestational age at delivery in severe preeclampsia ( 32. 5 weeks)was significantly less than that of mild preeclampsia group ( 37. 2 weeks) and normal group ( 38. 6 weeks,P ＜ 0. 05). However no significant differences were observed between mild preeclampsia group and normal group ( P ＞0. 05 ). The platelet count in severe preeclampsia ( 132 × 109/L) was significantly less than those of mild preeclampsia group (212 × 109/L) and normal group ( 216 × 109/L, P ＜ 0. 01 ), but no significant differences were observed in blood platelet amount between mild preeclampsia group and normal group ( P ＞0. 05 ). There was no significant difference in hemoglobin level and white blood cell in three groups ( P ＞0. 05). (2) The sCD40 plasma concentration in severe, mild preeclampsia and normal group was 133.6,126. 5 and 90. 7 ng/L, respectively. The sCD40 L plasma concentrations were 12. 5, 10. 4 and 4. 4 ng/L respectively in the 3 groups. 24 hours urinary protein quantitative was 4. 5 g/d,0. 8 g/d and 0 in the 3 groups respectively. And the UA level was 486 μ mol/L,289 μmol/L and 162 μmol/L. In the above three groups,the monitoring indicators were significantly higher in women with severe preeclampsia group compared with mild preeclampsia and control groups (P ＜ 0. 01 ), and there were also higher in mild preeclampsia group than that in control groups ( P ＜ 0. 01 ). The level of plasma Cr ( 89 μmol/L) and BUN ( 5. 32 mmol/L) in severe preeclampsia group were higher than those of mild preeclampsia group (66 μmol/L and 4. 49mmol/L) and control group ( 57 μmol/L and 3.32 mmol/L, P ＜ 0. 05 ). There was no significant difference between mild preeclampsia group and normal group (P ＞ 0. 05 ). (3) The correlation analysis indicated that the level of sCD40 has a positive correlation with 24 hours urinary protein quantitative( r = 0. 434, P ＜ 0. 05 ),also significant positive correlation( r =0. 536,0. 528 ,P ＜ 0. 01 ) between the level of sCD40 and UA or CRP in women with preeclampsia. There was no significant correlation between the level of sCD40 and systolic blood pressure, diastolic blood pressure, delivery gestational age, Cr, BUN, and platelet count(r =0. 135,0. 183, -0. 133,0. 190,0. 167, -0. 221 ,all P ＞0. 05 ). There were positive correlation between the level of sCD40L and 24 hours urine protein excretion, either UA or CRP( r =0. 591,0. 445,0. 539 ,all P ＜0. 01 ). No significant correlation was found between sCD40 L and systolic blood pressure, diastolic blood pressure,delivery gestational age, Cr, BUN, and platelet count( r =0. 178,0. 212, -0. 292,0. 144,0. 135, -0. 273,all P ＞0. 05). There was significant positive correlation between plasma sCD40 and sCD40L ( r =0. 707 ,P ＜0. 01 ). There was no relationship between the level of sCD40, sCD40L and the blood biochemical indexes in normotensive pregnant women ( P ＞ 0. 05 ). Conclusions The plasma concentrations of sCD40 and sCD40 L are significantly higher in pregnant women with preeclampsia compared with the control, which may be involved in the development of preeclampsia and contribute to the kidney damage. The variance levels of sCD40 and sCD40L may be also related to the severity of preeclampsia.