贵州医科大学学报

2018, v.43;No.211(04) 431-435

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大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病后的不良反应及血药浓度监测
Analysis of Adverse Reaction and Plasma Concentration Monitoring after High-dose Methotrexate Treatment in Children with Acute Lymphoblastic Leukemia

李静;黄璟;何志旭;吴莎莎;
LI Jing;HUANG Jing;HE Zhixu;WU Shasha;Department of Pediatrics,the Affiliated Hospital of Guizhou Medical University;

摘要(Abstract):

目的:观察大剂量甲氨蝶呤(HD-MTX)治疗儿童急性淋巴细胞白血病(ALL)的不良反应及血药浓度。方法:82例ALL患儿作为研究对象,给予HD-MTX治疗,于给药后第42、66 h时采用酶免疫增强法监测MTX血药浓度,并据血药浓度调整甲酰四氢叶酸钙(CF)解救剂量;观察用药后两个时间点不同MTX血药浓度时患儿的不良反应,不同MTX血药浓度患儿CF解救次数和解救剂量。结果:HD-MTX化疗后,42 h MTX浓度≤1.0μmol/L的ALL患儿CF解救次数、解救剂量及不良反应发生率低于42 h MTX浓度>1.0μmol/L的患儿,差异具有统计学意义(P<0.01);用药后66 h MTX浓度≤3.0μmol/L的ALL患儿CF解救次数、解救剂量及不良反应发生率低于66 h MTX浓度>3.0μmol/L的患儿,差异具有统计学意义(P<0.01)。结论:儿童ALL患者应用HD-MTX治疗,同一时间MTX血药浓度越大不良反应发生率越高,CF解救次数、解救剂量也越高。
Objective: To investigate the correlation between adverse reaction and plasma concentration in the treatment of children with acute lymphoblastic leukemia( ALL) by high-dose metoclopramide( HD-MTX). Methods: A total of 82 children with ALL in pediatric hematology wards of the Affiliated Hospital of Guizhou Medical University were selected as subjects,When HD-MIX was used,the plasma concentration was monitored regularly by an enzyme-linked method. The rescue dose of calcium formyltetrahydrofolate( CF) was adjusted according to the plasma concentration,and the adverse reaction of children was observed. Results: When HD-MIX was used,the incidence of adverse reaction accounted for 95. 9 % in children with MTX concentration > 1. 0 μmol/L at 42 h; The incidence of adverse reaction was 90. 9 % in children with MTX concentration ≤1. 0 μmol/L at 42 h; The incidence of adverse reaction accounted for 95. 5 % in children with MTX concentration > 0. 3 μmol/L at66 h; The incidence of adverse reaction accounted for 92. 1 % in children with MTX concentration ≤0. 3 μmol/L at 66 h. The main adverse reaction to HD-MIX was bone marrow suppression,liver and kidney function damage,mucosal damage and so on. Plasma MTX concentration monitoring,timely adjusted the rescue dose,most of the children treated smoothly,no serious and fatal adverse reaction.The adverse effects of HD-MTX on children with ALL mainly included myelosuppression,cardiac function damage,liver and kidney function damage,gastrointestinal reaction and mucosal damage.Conclusion: The higher the concentration of MTX,the higher the incidence of adverse reaction in the same period of time as HD-MIX was used for children with ALL; Monitoring MTX plasma concentration is helpful to adjust calcium plasma rescue dose in time,reducing MTX plasma concentration in time can reduce and prevent the occurrence of severe adverse reaction of methotrexate.

关键词(KeyWords): 甲氨蝶呤;白血病,淋巴细胞,急性;儿童;甲酰四氢叶酸钙;血药浓度;不良反应
metoclopramide;leukemia,lymphoblastic,acute;children;formyltetrahydrofolate;plasma concentration;adverse reaction

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技计划项目[黔科合LH字(2017)7194号]

作者(Author): 李静;黄璟;何志旭;吴莎莎;
LI Jing;HUANG Jing;HE Zhixu;WU Shasha;Department of Pediatrics,the Affiliated Hospital of Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2018.04.012

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