儿童急性淋巴细胞白血病应用大剂量甲氨蝶呤后黏膜损伤临床观察

Clinical observation of mucosal injury after high-dose methotrexate chemotherapy in children with acute lymphoblastic leukemia

目的探讨儿童急性淋巴细胞白血病(ALL)患者应用大剂量甲氨蝶呤(HD-MTX)化疗后黏膜损伤发生情况,及其与甲氨蝶呤血药浓度、危险度分层及临床疗效的关系。方法回顾性分析哈尔滨市第一医院2015年11月至2018年10月95例ALL患儿资料,患儿共接受539例次HD-MTX化疗。分析患儿黏膜损伤情况与甲氨蝶呤血药浓度、疾病危险程度及临床疗效的关系。结果95例患儿539例次HD-MTX化疗中,总体黏膜损伤发生率为8.4%(45/539);低危组黏膜损伤发生率为4.6%(11/239),中危组为7.6%(8/105),高危组为13.3%(26/195)。随着疾病危险程度的提升,黏膜损伤发生率增高(χ^2=10.787,P<0.05)。黏膜损伤程度与甲氨蝶呤血药浓度及疾病危险程度均无关(均P>0.05),黏膜损伤发生与否与疾病临床疗效无关(P>0.05)。结论ALL患儿应用HD-MTX后通过监测甲氨蝶呤血药浓度来调整解救药物剂量,提高用药安全性。

Objective To investigate mucosal injury after high-dose methotrexate(HD-MTX)chemotherapy in treatment of children with acute lymphoblastic leukemia(ALL),and to analyze the association with methotrexate blood concentration,risk stratification and clinical efficacy.Methods The data of 95 children with ALL who received 539 times of HD-MTX chemotherapy in the First Hospital of Harbin from November 2015 to October 2018 were retrospectively analyzed,and the association of mucosal injury with methotrexate blood concentration,disease risk degree and clinical efficacy was also analyzed.Results Among 95 children who received 539 times of HD-MTX chemotherapy,the total incidence of mucosal injury was 8.4%(45/539);the incidence of mucosal injury was 4.6%(11/239),7.6%(8/105),13.3%(26/195),respectively in the low-risk group,middle-risk group and high-risk group.With the elevation of disease risk,the incidence of mucosal injury was increased(χ^2=10.787,P<0.05).There was no correlation of the degree of mucosal injury with methotrexate blood concentration and disease risk degree(all P>0.05),and the mucosal injury was not related with the clinical efficacy(P>0.05).Conclusion After the application of HD-MTX in children with ALL,adjustment of the dose of rescue drug by monitoring of methotrexate blood concentration can improve the safety of therapeutic drugs.