大剂量甲氨蝶呤在急性淋巴细胞白血病应用后两种解毒方法的比较

Comparison of two detoxification methods to high-dose Methotrexate in treating acute lymphoblastic leukemia

目的探讨大剂量甲氨蝶呤(MTX)治疗急性淋巴细胞白血病的有效解救方法。方法选取我院收治的急性淋巴细胞白血病患者45例,随机分成观察组(23例)和对照组(22例)。45例患者均应用大剂量MTX进行治疗,观察组患者监测血药浓度并随时调整解救药的剂量,对照组患者应用固定剂量的解救药进行解救。比较两组患者不良反应的发生情况。结果观察组皮肤黏膜损害、胃肠道反应、肝功能损害、肾功能损害、骨髓抑制的发生率均低于对照组,且两组胃肠道反应、肝功能损害、骨髓抑制发生率的差异具有统计学意义(P<0.05)。结论在应用大剂量MTX进行治疗的过程中进行血药浓度的密切监测并及时调整解救药浓度能够达到更好的治疗效果。

Objective To investigate the effective rescue method to high-dose Methotrexate （MTX） in treating acute lymphoblastie leukemia. Methods A total of 45 patients with acute lymphoblastic leukemia in our hospital were selected and randomly divided into trial group （ n = 23 ） and control group （n = 22）. All the patients were treated with high-dose of MTX. In the trial group, the plasma drug concentrations were monitored and the dose of antidote was adjusted accordingly in time. The control group received a fixed dose of rescue medicine. The incidence of adverse reactions was compared between the two groups. Results The incidence of skin mucous membrane damage, gastrointestinal tract reaction, hepatic function damage, renal function damage and marrow suppression of the trial group were lower than that of the control group, with a significant difference in gastrointestinal tract reaction, hepatic function.damage and marrow suppression between the two groups （P 〈 0.05 ）. Conclusion During MTX treatment process, close monitor of its plasma drug concentration and timely adjustment help to achieve better therapeutic effect.