广西儿童急性淋巴细胞白血病甲氨蝶呤血药浓度监测的意义

Significance of methotrexate blood concentration monitoring in the children with acute lymphoblastic leukemia in Guangxi Region

目的:研究监测甲氨蝶呤血药浓度对大剂量甲氨蝶呤加亚叶酸钙方案治疗儿童急性淋巴细胞白血病的作用。方法:收集进行甲氨蝶呤血药浓度监测前后使用大剂量甲氨蝶呤加亚叶酸钙化疗的急性淋巴细胞白血病儿童的病例,对用药特点、给药方式和出现的不良反应进行统计分析和临床安全性评价。结果:开展血药浓度监测前病例所出现的不良反应发生率为75.1%,与开展血药浓度监测后的病例出现的不良反应发生率79.6%相比,差异无显著性;但开展血药浓度监测后病例出现的不良反应比监测前的明显减轻,严重不良反应发生率为21.95%,与之前的严重不良反应发生率36.51%相比,差异有显著性。结论:大剂量甲氨蝶呤加亚叶酸钙治疗儿童急性淋巴细胞白血病时,会出现化疗过程中的各种不良反应;但进行甲氨蝶呤血药浓度监测能及时有效的进行亚叶酸钙解救,可减少和预防甲氨蝶呤严重不良反应的出现。

OBJECTIVE To study the benefit of the methotrexate blood concentration monitoring which is used in the treat ment of the children with acute lymphoblastic leukemia in Guangxi region. METHODS Investigating the children cases with acute lymphoblastic leukemia that are chemotherapied by the means of using high-dose methotrexate plus calcium folinate before and after carrying on methotrexate blood concentration monitoring, collect and analyze the adverse drugs＇reactions （ADRs） be tween them. RESULTS the incidences of the adverse reaction of the cases without monitoring methotrexate concentration are same as those cases with monitoring its concentration; but the incident rates of ADRs with monitoring methotrexate concentration are less serious than those without monitoring its concentration. CONCLUSION Monitoring the methotrexate blood concentration can help to use calcium folinate to detoxificate rnethotrexate timely and efficiently when treating the children acute lymphoblastic leukemia with high-dose methotrexate, It can prevent and reduce the incidences of the serious adverse reactions of methotrexale.