Objective To analyze the effectiveness of conservative medical treatments for ectopic pregnancy (EP): methotrexate (MTX) + mifepristone + Ectopic Pregnancy II decoction (EP-II) vs. methotrexate + mifepristone. Methods A total of 95 patients with EP in Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University from January 2009 to January 2011 were randomly divided into two groups: 45 patients in the experimental group were treated with MTX, mifepristone and EP II decoction, while the other 50 patients in the control group were treated with MTX and mifepristone. The effectiveness of the two groups was analyzed with SPSS 13.0 software. Results There were significant differences in the time of serum β-HCG return to normal (16.13±8.13 ds vs. 22.05±7.15 ds, Plt;0.05), time of EP mass absorption (30.46±7.56 ds vs. 39.99±18.26 ds, Plt;0.05) and tubal patency rate (80% vs. 75%, Plt;0.05) between the two groups. But there were no significant differences in effective rate (95.56%, 43/45 vs. 94%, 47/50, χ2=0.0809, Pgt;0.05) and side effects. Conclusion The combination of methotrexate, mifepristone and EP II decoction for ectopic pregnancy is more effective than mifepristone and methotrexate in coordinately killing the embryo, shortening the time of serum β-HCG return to normal and the time of EP mass absorption, and improving the function of oviducts.
目的 為紅皮病型銀屑病患者制定循證治療方案。 方法 2012年3月收治1例紅皮病型銀屑病患者，充分評估患者情況后，提出臨床問題，計算機檢索Cochrane圖書館、 Medline、中文全文期刊醫學數據庫中相關研究，根據檢索結果結合患者實際情況，制定治療方案。 結果 共檢索到相關文獻3篇。通過對檢索結果進行分析，并結合患者意愿，為患者制定了采用甲氨喋呤的治療方案。經過6個月的治療隨訪，證實該方案適合該患者。 結論 采用循證醫學的方法，為紅皮病型銀屑病患者制定合理的治療方案，可提高療效。
Objective To evaluate the efficacy and safety of Leflunomide (LEF) in the treatment of Rheumatoid Arthritis (RA), so as to provide scientific proof for applying LEF in China. Methods Randomized controlled trials (RCTs) about the effect of LEF on patients with RA from January 1989 to January 2011 were searched from the following databases, CNKI, WanFang Data, MEDLINE, EMbase and CBM. After two reviewers independently screened the studies according to the inclusion and exclusion criteria, extracted the data and assessed the quality, the data were analyzed by RevMan 5.0 software. Results Among 3247 patients in 16 included RCTs, 1711 patients were in the LEF group, while the other 1536 patients were in the Methotrexate (MXT) group. The results of meta-analyses showed there was no significant difference in the efficacy between LEF and MXT (RR=1.03, 95%CI 0.94 to 1.11, Pgt;0.05), but a significant difference was found in the side reaction (RR=0.67, 95%CI 0.49 to 0.94, Plt;0.05). Conclusion Based on the current studies, Leflunomide is as effective as the commonly-used Methotrexate in the treatment of rheumatiod arthritis at present, much safer than Methotrexate, and thought as a safe and effective SAARD. For the quality restrictions of the included studies, more double blind RCTs with high quality are required to further assess the effects.
ObjectivesTo analyze patients’ values and preferences on individualized medication of high-dose methotrexate so as to support the development of the practice guideline for clinical medication of high-dose methotrexate.MethodsA multicenter cross-sectional study involving patients with osteosarcoma or hematological malignancy in 7 hospitals was conducted by questionnaires to evaluate the perception and willingness on detection of gene polymorphisms (MTHFR C677T, MTHFR A1298C, ABCB1 C3435T and RFC1 G80A) related to methotrexate (MTX) and therapeutic drug monitoring (TDM) of MTX. SPSS24.0 software was used to analyze the data.ResultsA total of 124 patients were involved, including 40 (32.26%) with osteosarcoma and 84 (67.74%) with hematological malignancy. 106 (85.48%) and 117 (94.35%) patients agreed on detection of gene polymorphisms and TDM, respectively. There was a significant difference on preference towards TDM between patients with risk factors for MTX and patients in which risk factors for MTX were not discovered (76.19% vs. 95.08%, P=0.003). The ranking of factors that contributed to the two decision-making was consistent (P<0.01), and specific orders of factors were identical. The clinical efficacy was the primary factor (mean rank 3.45 for detection of genetic polymorphisms and 3.52 for TDM), followed by safety (mean rank 3.01 and 3.16, respectively) and comfort (mean rank 1.73 and 1.79, respectively). Cost (mean rank 1.39 and 1.31, respectively) was the least important factor.ConclusionsThe preferences of patients toward detection of gene polymorphisms and TDM were generally similar, with well acceptance. No significant differences were found on the preferences toward detection of gene polymorphisms. However, patients with or without risk factors for MTX may differ significantly when making decisions on TDM, which may impact on clinical decision-making of clinicians and clinical pharmacists. The perception and willingness of patients should be considered adequately during the development of clinical practice guidelines and clinical practice.
【摘要】 目的 探討甲氨蝶呤(MTX)聯合米非司酮治療早期異位妊娠(EP)的臨床效果。 方法 收集2006年2月-2010年2月收治的早期未破裂型EP患者126例，隨機分為MTX聯合米非司酮組62例，單獨應用MTX組64例， MTX治療采用小劑量分次肌肉注射給藥進行。 結果 126例患者中，MTX聯合米非司酮組和單獨應用MTX治療組的成功率為分別為88%和65%，兩組差異有統計學意義(Plt;0.05)。 結論 MTX小劑量分次給藥聯合米非司酮治療早期未破裂型EP效果優于MTX的單獨使用。【Abstract】 Objective To observe the therapeutic effect of methotrexate (MTX) combined with mifepristone on early ectopic pregnancy. Methods A total of 126 patients with early ectopic pregnancy diagnosed from February 2006 to Febrary 2010 were randomly divided into two groups. In 126 patients, 62 treated with MTX combined with mifepristone were in the treatment group,and 64 treated independently with MTX were in the control group. MTX was administrated at a low dose in several times. Results In 126 patients,the success ratio of the treatment was 88% in treatment group groups and 65% in the control group; the difference between the two groups was significant (Plt;0.05). Conclusion Low-dose MTX in separate times combined with mifepriston is effective on the early ectopic pregnancy, and the therapeutic effect of the combined administration of MTX and mifepriston is better than that of the single administration with MTX.
Objective To explore the clinical effect of intramuscular injection of methotrexate on hysteroscopic treatment of endogenous cesarean scar pregnancy (CSP). Methods A prospective analysis was conducted on 94 patients diagnosed with endogenous CSP who visited the Department of Gynecology in Liuzhou Workers’ Hospital between January 2013 and January 2018, and they were randomly divided into two groups, the intramuscular injection of methotrexate followed by hysteroscopic surgery group (the methotrexate group, n=39) and the direct hysteroscopic surgery group (the non-methotrexate group, n=55). The operation time, intraoperative blood loss, surgical complications, length of hospital stay, hospitalization expenses, the recovery time of blood human chorionic gonadotropin (HCG) and treatment outcomes of the two groups were compared. The normally distributed data were expressed as mean±standard deviation, and the non-normally distributed data were expressed as median (lower quartile, upper quartile). Results There was no statistically significant difference in age, gestational sac diameter, uterine scar thickness, number of cesarean sections, time from cesarean section to present, time of menopause, or preoperative blood HCG value between the two groups (P>0.05). There was no statistically significant difference in intraoperative blood loss [75 (35, 120) vs. 65 (35, 130) mL, P=0.821], incidence of complications (5.1% vs. 5.5%, P=1.000), postoperative blood HCG recovery time [(5.22±2.17) vs. (4.96±1.81) weeks, P=0.559] or the effective rate of treatment (94.9% vs. 90.9%, P=0.747) between the two groups. The methotrexate group had longer operation time [43 (34, 55) vs. 32 (28, 35) min, P=0.001], longer length of hospital stay [(10.89±1.42) vs. (5.82±1.47) d, P<0.001], and higher hospitalization cost [(8596.46±3336.59) vs. (7058.84±2638.49) yuan, P=0.014]. Conclusion For patients with endogenous CSP, intramuscular injection of methotrexate before hysteroscopic surgery is not necessary, for it has no significant impact on the treatment effect, instead, it may prolong the operation time and length of hospital stay, and increase the hospitalization cost.
目的:探討甲氨蝶呤聯合依那西普(MTX+ETA)和甲氨蝶呤聯合來氟米特(MTX+LEF)治療重度活動的類風濕關節炎(RA)的療效差異。方法:收集重度活動的RA患者50例。A組24例,給予MTX 10mg/次,一周一次,口服,聯合ETA 25mg/次,一周2次,皮下注射后病情緩解后依那西普減量為25mg/次,1周一次至隨訪結束;B組26例,給予MTX 10mg一周一次聯合來氟米特20mg/d。兩組隨訪時間為24周。定期隨訪其紅細胞沉降率(ESR)、C反應蛋白(CRP)、DSA28評分、sharp評分、RF、ANA、ACR核心標準評定。結果:①A組在治療半年前后其VAS評分、晨僵時間、關節腫痛個數、DSA28評分、HAQ、患者評分、醫生評價、ESR、CRP方面改善明顯,有統計學意義(Plt;0.05);B組在治療半年前后其VAS評分、晨僵時間、關節腫痛個數、DSA28評分、HAQ、患者評分、醫生評價方面改善明顯,有統計學意義(Plt;0.05);A組和B組在治療半年后在VAS評分、晨僵時間、關節觸痛個數、DSA28評分、HAQ、患者評分、醫生評價、ESR、CRP方面改善明顯,有統計學意義(Plt;0.05)。②各組ACR20有效率逐步增加,在各隨訪期內兩組的ACR20的達標率的差異無明顯的統計學意義(Pgt;0.05);ACR50則在第4、20、24周,A組的達標率為12%、79%、87%與B組的8%、46%、50%差異有統計學意義(Plt;0.05);ACR70雖然在各期A組均高于B組,但差異均無差異性(Pgt;0.05)。③A組在第2、4、12周DSA28指數下降明顯,跟前次隨訪指標的差異有統計學意義(Plt;0.05);B組在第16、24周DSA28指數下降明顯,跟前次隨訪指標的差異有統計學意義(Plt;0.05);而A組與B組同期DSA28的比較發現,A組從第4周起各期DSA28分值均低于B組,且差異均有統計學意義(Plt;0.05)④兩種治療方案不良反應發生情況均低,且兩組不良事件發生率差異無統計學意義。結論:ETA+MTX和LEF+MTX聯合治療重度活動的RA均是安全有效的,其中前者常常可以更早期的達到誘導緩解病情的目的。
Primary vitreoretinal lymphoma (PVRL) is one of the most common type of primary intraocular lymphoma. The current treatment options include local ocular radiotherapy (radiotherapy), systemic chemotherapy (chemotherapy), local ocular chemotherapy, and combination therapy. The treatment options are different at different stages of PVRL, however, there is no uniform treatment guideline. Local ocular chemotherapy can make the drug reach effective therapeutic concentration in the eye, and it can be repeated many times. At the same time, it can avoid the adverse reactions caused by systemic medication or radiotherapy. It is an ideal choice for relieving ocular symptoms. At present, the mainstream ocular local chemotherapeutics are methotrexate (MTX) and rituximab (RTX). The basic consensus about the intravitreal injection of MTX (IVM) is the induction-consolidation-maintenance model, however, the time of each stage and frequency of IVM are diverse. The time interval of intravitreal injection of RTX is also variable, ranging from 1 time/week to 1 time/months and so on. Corneal epithelial lesions caused by frequent MTX injections and the higher recurrence rate after RTX treatment are the main reasons for changing the treatment plan. For patients with primary central nervous system lymphoma and PVRL, combined treatment with neurology department is necessary to save patient's lives, ophthalmology treatment relieves ocular symptoms and improves the patient's quality of life. For patients with PVRL alone without central nervous system involvement, ophthalmology treatment is necessary to control patient's eye symptoms, and close follow-up should be followed to find the involvement of the central nervous system in time, and then combined with neurological treatment to save patient’s lives.
目的 探討子宮動脈化療栓塞在剖宮產術后子宮切口妊娠治療中的可行性和安全性。 方法 回顧分析2006年7月－2011年3月收治的152例剖宮產切口瘢痕妊娠行介入治療的病例資料。 結果 152例子宮動脈化療栓塞操作均成功。陰道大出血或不規則出血均得到有效控制。人絨毛膜促性腺激素β亞型較術前下降，差異有統計學意義（Z=?9.295，P=0.000），術后2～22 d行清宮術，術中失血3～100 mL，平均27 mL。3例行子宮切除術，子宮切除率2%。1例發生栓子脫落導致左下肢脛前動脈栓塞并發癥。 結論 子宮動脈化療栓塞治療剖宮產術后切口妊娠可有效控制大出血、降低清宮風險、降低子宮切除風險，是治療切口妊娠的有效可行方法之一。