大剂量甲氨蝶呤治疗急性淋巴细胞白血病的不良反应

Observation of Clinical Side Effects of High-Dose-Methotrexate in Treating Children with Acute Lymphoblastic Leukemia

目的研究大剂量甲氨蝶呤(HD-MTX)加四氢叶酸钙(CF)解救方案治疗儿童急性淋巴细胞白血病(ALL)的不良反应。方法82例ALL患儿进行139例次的HD-MTX加CF治疗。根据44 h MTX血药质量浓度分为A组(44 h MTX浓度≤1.0 mmol/L),B组(44 h MTX浓度>1.0 mmol/L)。对用药前后两组患儿不良反应观察,并进行对照研究。结果骨髓抑制、肝功能损害、胃肠道反应、感染发生率两组比较无显著性差异。但随着血药质量浓度增加,皮肤黏膜损害、心电图异常和心肌酶谱异常、神经系统症状发生率均显著增加,两组比较有显著性差异。结论HD-MTX加CF治疗儿童白血病时,不良反应较为常见,个体差异较大,应加强个体化治疗。

Objective To study the clinical side effects of high dose- methotrexate（HD-MTX） and leueovorin（CF） in treating children with acute lymphatic leukemia （ALL）. Methods Eighty two cases of children with ALL received the treatment with HDMTX ＋ CF for 139 courses. According to the methotrexate（MTX） blcod drug level of 44 hours, they were divided into 2 groups： the group A（MTX blood drug level of 44 hours≤1.0 mmol/L）and the group B（MTX blood drug level of 44 hours〉 1.0 mmol/L）. The clinical side effects after medication circa were compared between two groups. Results There was no significant difference in myelosuppression, liver functional lesion, gastrointestinal tract reaction and infection in 2 groups. But following the increase of MTX blood drug level, the incidence rate of skin mucosa eontamintion, electrocardiographic abnormality, the cardiac creatase abnomity and nervous system symptoms significantly increased. Conclusions In the course of child ALL treatment with HD-MTX ＋ CF, the side effects are contain and individtual difference is obvious. Specific treatment on individuals is suggested.