大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的临床分析

Clinical analysis of the treatment of childhood leukemia with high-dose methotrexate

目的 分析应用大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病（ALL）的临床效果.方法对31例标危型和27例中高危型ALL患儿分别采用中剂量（3 g/m2,静脉滴注,1次/10 d）、高剂量（5 g/m2,静脉滴注,1次/10 d）甲氨蝶呤治疗,监测其血药浓度和排泄延迟率,观察不良反应发生情况以及治愈率.结果中剂量组44 h血药浓度（1.21±0.23）μmol/L,68 h血药浓度（0.39±0.14）μmol/L,高剂量分别是（1.02±0.21）和（0.21±0.09）μmol/L,2组差异有统计学意义（t=6.010、7.123,P＜0.01）;排泄延迟率2组差异无统计学意义（P＞0.05）;中剂量组和高剂量组均可发生皮肤损坏、黏膜炎、肝肾功能损害、消化道反应、血液学改变、感染等并发症;总的治愈率为79.3%（46/58）,中高危型患儿的治愈率为66.7%（18/27）,标危型患儿的治愈率为90.3%（28/31）,明显高于中高危型患儿（66.7%）（18/27）,差异有统计学意义（χ2=17.95,P＜0.05）.2组不良反应比较差异无统计学意义（P〉0.05）.结论 大剂量甲氨蝶呤治疗儿童ALL可提高治疗效果.

Objective To study the effect of the treatment for childhood leukemia with high-dose methotrexate. Methods Totally 58 cases of children patients in Yichang second people＆#39;s hospital of Hubei Province were observed regarding the clinical effect of the middle-high-dose middle-dose（3 g/m2, intravenous injection, every ten days time） regarding high-dose（5 g/m2, intravenous injection, every ten days time） methotrexate in the treatment. The blood concentration, discharge delay rate and adverse reaction were monitored. Results The plasma concentration of middle-dose group in 44 h and 68 h was （1.21±0.23） μmol/L and （0.39±0.14） μmol/L; it was （1.02±0.21） μmol/L and （0.21±0.09） μmol/L in high-dose group. The data of the two groups was significantly different （t=6.0104, 7.1231, P〈0.01）. The discharge delay rate of the two groups were different with statistical significance. The two groups had adverse reactions of skin damage,blennophlogisma, liver and kidney function damage, the digestive tract reaction, the change of the hematology and infection. The total cure rate was 79.3%, the cure rate in children with middle-high-risk type was 66.7%（18/27）; the cure rate in children with standard-risk type was 90.3%（28/31）, which was significantly higher than that in high-risk patients （66.7%）（18/27）（χ2=17.95, P〈0.05）. Conclusion The application of treatment of high-dose methotrexate for children with childhood leukemia can effectively improve the treatment effect and reduce the degree of adverse reactions.