大剂量甲氨蝶呤在儿童急性淋巴细胞白血病化疗中不良反应及清除延迟的影响因素分析

Adverse Drug Reactions of High-Dose Methotrexate in Children with Acute Lymphoblastic Leukemia Chemotherapy and Influencing Factors of Delayed Elimination

目的:探讨大剂量甲氨蝶呤(HD-MTX)化疗的相关不良反应及清除延迟的影响因素,保证患儿用药的合理性及安全性,提高远期预后。方法:回顾性分析2020年8月至2022年1月在我院儿科住院,诊断为急性淋巴细胞白血病,且接受HD-MTX化疗患儿的相关资料,分析患儿在HD-MTX化疗过程中不良反应发生情况及清除延迟的影响因素。结果:35例急性淋巴细胞白血病患儿共接受128例次HD-MTX化疗,化疗不良反应以骨髓抑制最常见,占46.9%,其次为肝功能损害,占25.8%。年龄越小,HD-MTX化疗胃肠道紊乱发生率越高。危险度越高(中高危组),骨髓抑制的发生率越高。MTX的清除延迟会增加黏膜损害、肝损害、胃肠道不良反应的发生。结论:清除延迟时不良反应的发生风险明显增加,应及时监测及解救。

Objective:To investigate the adverse drug reactions related to high-dose methotrexate(HD-MTX)chemotherapy and influencing factors of delayed elimination,so as to ensure the rationality and safety of children’s medication and improve the long-term prognosis.Methods:Relevant data of children admitted into pediatrics of our hospital from Aug.2020 to Jan.2022,diagnosed with acute lymphoblastic leukemia,and received HD-MTX chemotherapy were retrospectively analyzed.Occurrence of adverse drug reactions in children during HD-MTX chemotherapy and influencing factors of delayed elimination were analyzed.Results:Thirty-five children with acute lymphoblastic leukemia received a total of 128 cases of HD-MTX chemotherapy,and myelosuppression(46.9%)was the most common adverse drug reactions of chemotherapy,followed by liver injury(25.8%).The younger the age,the higher the incidence of gastrointestinal disorders in HD-MTX chemotherapy. The higher the risk (medium and high risk group), the higher the incidence of myelosuppression. Delayed elimination of MTX could increase the occurrence of mucosal damage, liver injury, gastrointestinal adverse drug reactions. Conclusion: The risk of adverse drug reactions increases significantly when elimination is delayed and should be monitored and relieved promptly.