目的 分析甲氨蝶呤治療異位妊娠致肝損傷的臨床特點和影響因素，為臨床安全用藥提供參考。方法 收集2018年1月1日-2020年5月31日使用甲氨蝶呤治療的異位妊娠患者病歷資料，回顧性分析患者肝損傷的臨床特點，以及患者特征和藥物因素對肝損傷的影響。結果 共納入320例患者，其中49例發(fā)生肝損傷，發(fā)生率為15.31%。臨床分型均為肝細胞損傷型，RUCAM量表評分均在3分以上，38例（77.55%）≥ 6分。肝損傷多發(fā)生在停藥后3 d內，嚴重程度主要為2級和3級。28例經保肝治療后痊愈或好轉，12例未經治療自行痊愈或好轉，9例未復查。分析顯示，患者年齡（P=0.98）、體質量指數（P=0.19）、乙型肝炎表面抗原（HBsAg）是否陽性（P=0.13）和異位妊娠類型（P=0.78）均與肝損傷無關。不同治療方案（P<0.01）和合并使用致肝功能異常藥物（P<0.05）與肝損傷有關，預防性使用保肝藥物未見對肝損傷有影響（P=0.92）。結論 甲氨蝶呤引起的肝損傷發(fā)生較早，具有可逆性。5 d連續(xù)給藥方案和合并使用致肝功能異常藥物的患者更易引發(fā)肝損傷，建議加強監(jiān)測肝功能，個體化選擇治療方案，避免不合理的聯合用藥。

Objective To investigate the clinical characteristics and effect factors of liver injury induced by methotrexate after treatment for ectopic pregnancy, and to provide reference for clinical safe drug use. Methods The medical records of ectopic pregnancy patients treated with methotrexate from January 1, 2018 to May 31, 2020 were collected to retrospectively analyze the clinical characteristics of liver injury and the influence of patient characteristics and drug factors on liver injury. Results A total of 320 patients were enrolled, 49 of whom developed liver injury (15.31%), the clinical classification was hepatocyte injury type, RUCAM scale score were all above 3, and 38 cases (77.55%) were more than 6 points. Liver injury mostly occurred within 3 days after drug withdrawal, and the severity was grade 2 and 3. 28 cases were cured or improved after liver preservation treatment, 12 cases were cured or improved without treatment, and 9 cases were not reviewed. Analysis showed that age (P=0.98), body mass index (P=0.19), HBsAg positive (P=0.13), and ectopic pregnancy type (P=0.78) were not associated with liver injury. Different treatment regiments (P<0.01) and combined use of abnormal liver function drugs (P<0.05) were associated with liver injury, while preventive use of liver-protecting drugs had no effect on liver injury (P=0.92). Conclusion Methotrexate induced liver damage occurred earlier and was reversible. Patients with 5-day continuous administration regimen and combined use of drugs causing abnormal liver function are more likely to cause liver injury. It is suggested to strengthen monitoring of liver function and individual selection of treatment regimen to avoid unreasonable combination medication.

R969.3