甲氨蝶呤化疗的血药浓度监测及意义

Serum concentration monitoring and significance of methotrexate in patients with osteosarcoma undergoing chemotherapy

目的观察大剂量甲氨蝶呤(MTX)化疗在骨肉瘤治疗中血药浓度监测的意义。方法30例骨肉瘤患者接受30例次大剂量MTX化疗,每次6～10g/m2,应用后6h用亚叶酸钙(CF)解救。监测用药后MTX的血药浓度。结果用药后0、24、48、72hMTX的血药浓度分别为(388.84±101.06)μmol/L、(7.00±7.18)μmol/L、(0.98±1.17)μmol/L、(0.31±0.37)μmol/L。结论MTX在体内处置个体差异大,监测血清MTX浓度,充分水化、碱化,适时CF解救,是保证大剂量使用MTX临床安全的关键因素。

Objective To evaluate the significance of monitoring serum concentration of methotrexate（MTX）in patients with osteosarcoma undergoing chemotherapy.Methods A large gose of methotrexate chemotherapy with curative scheme of thirty cycles of HD-MTX 6-10g/m2 was performed in 30 patients with osteosarcoma.The serum concentrations of methotrexate within 72h were measured using high performance liquid chromatography.Calcium folinate was given at 6h after MTX.Results Serum concentrations of MTX at 0,24,48 and 72h after MTX were（388.84±101.06）μmol/L,（7.00±7.18）μmol/L,（0.98±1.17）μmol/L and（0.31±0.37）μmol/L,respectively.Conclusion MTX has a large individual variation in disposition.The key factor for the safety of MTX chemotherapy with large dose is based on the serum concentration monitoring of MTX to guaraentee adequate hydration and alkalization and detoxification properly with calcium folinate.