大剂量甲氨蝶呤血药浓度测定对甲酰四氢叶酸钙使用的影响

Effect of Plasma Concentration of Large Dose of Methotrexate on the Application of Citrovorum Factor

目的:指导临床合理应用解救剂,减少甲氨蝶呤(MTX)不良反应发生。方法:对于需要使用大剂量MTX的患者,根据疾病种类不同,按诊疗规范规定使用大剂量MTX,静脉滴注MTX结束后一定时间内,使用甲酰四氢叶酸钙(CF)进行解救,测定24、44、68hMTX的血药浓度,直至MTX的血药浓度降至0.1μmol·L-1以下,停止CF解救。结果:12例监测结果中,1例患者24h的血药浓度低于有效浓度范围,1例患者44h血药浓度、5例患者68h的血药浓度高于安全浓度。结论:由于个体差异存在,大剂量使用MTX的患者,血药浓度监测非常必要。

OBJECTIVE：To guide the rational use of rescue agents and to decrease the incidence of ADR induced by methotrexate（MTX）.METHODS：Patients were given large dose of MTX according to the type of disease,diagnosis and treatment regulation.Calcium folinate（CF） was used for rescue treatment after intravenous administration of MTX.Plasma concentrations of MTX were determined at 24,44,68 h respectively.Rescue treatment was not ended until the plasma concentration of methotrexate reached 0.1 μmol·L-1.RESULTS：Of total 12 cases,plasma concentration of one case at 24 h was below effective concentration.Plasma concentration of one case at 44 h and that of 5 cases at 68 h were higher than safe concentration.CONCLUSION：It is necessary to monitor plasma concentration in patients treated with large dose of MTX because of individual differences.