大剂量甲氨蝶呤治疗血液系统恶性肿瘤排泄延迟危险因素分析

High-dose methotrexate treatment for malignant tumors of the hematologic system:analysis of risk factors for delayed excretion

目的本研究旨在探究急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)和非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)患者在接受大剂量甲氨蝶呤(high-dose methotrexate,HD-MTX)化疗后可能出现排泄延迟情况,以及可能影响这一情况的因素,为个体化给药提供临床参考依据。方法收集2023年2月~2023年7月在中南大学湘雅医院就诊的急性淋巴细胞白血病和非霍奇金淋巴瘤患者接受完整化疗的数据。采用SPSS 25.0软件对接受HD-MTX化疗的患者在治疗期间排泄延迟情况以及各方面的影响因素进行了分析。结果所有纳入研究的患者中,化疗期间排泄延迟的总发生率为30.9%。ALL小儿组的发生率为29.7%,ALL成人组的发生率为54.2%,NHL组的发生率为24.6%。与排泄正常组的患者比较,在发生排泄延迟的患者中,ALL小儿组与NHL组不良反应发生率均存在显著差异(P<0.01);ALL成人组与NHL组中,化疗前肌酐(Cr)水平的高低均存在显著差异(P<0.05);ALL小儿组、NHL组中分别有两类药物具有显著性差异:胃黏膜保护类药物(P=0.035)、心脏保护类药物(P=0.013)。Logistic回归分析结果表明,不良反应是ALL小儿组和NHL组发生排泄延迟的独立危险因素(ALL小儿组:OR=6.454,P=0.007;NHL组:OR=9.751,P=0.001);在小儿组中,T型疾病分型是发生排泄延迟的独立危险因素(OR=3.989,P=0.039)。结论化疗前肌酐(Cr)水平可能与排泄延迟相关,不良反应的发生情况和T细胞型ALL患儿也是发生排泄延迟的危险因素。

Objective This study aims to explore the occurrence of delayed excretion and its related influencing factors in patients with acute lymphoblastic leukemia(ALL)and non-Hodgkin lymphoma(NHL)receiving high-dose methotrexate(HD-MTX)chemotherapy,in order to provide clinical reference for individualized dosing.Methods Complete chemotherapy data of patients with ALL and NHL who were treated at Xiangya Hospital of Central South University from February 2023 to July 2023 were collected.SPSS 25.0 software was used to analyze the occurrence of delayed excretion and its influencing factors during treatment in patients receiving HD-MTX chemotherapy.Results In all patients included in the study,the overall incidence of delayed excretion during chemotherapy was 30.9%.The incidence rates were 29.7%for pediatric ALL,54.2%for adult ALL,and 24.6%for NHL.When compared with patients in the normal excretion group,there were significant differences in the occurrence of adverse reactions in both the pediatric ALL and NHL groups(P<0.01);in the adult ALL and NHL groups,there were significant differences in pre-chemotherapy creatinine(Cr)levels(P<0.05).Two types of drugs in the pediatric ALL and NHL groups respectively showed significant differences:gastric mucosal protective drugs(P=0.035)and cardiac protective drugs(P=0.013).Logistic regression analysis results indicated that adverse reactions were independent risk factors for the occurrence of delayed excretion in both pediatric ALL(OR=6.454,P=0.007)and NHL(OR=9.751,P=0.001)groups.In the pediatric group,the T-type disease subtype was identified as an independent risk factor for delayed excretion(OR=3.989,P=0.039).Conclusion Pre-chemotherapy creatinine(Cr)levels may be associated with delayed excretion,and the occurrence of adverse reactions,as well as T-cell type ALL in pediatric patients,are also risk factors for delayed excretion.