大剂量氨甲蝶呤治疗恶性肿瘤的血药浓度监测

High dose methotrexate treatment for malignant tumor and the serum concentration monitoring

目的 :探讨大剂量氨甲蝶呤 (MTX)用药后血药浓度监测的临床意义。方法 :应用大剂量氨甲蝶呤加四氢叶酸钙 (CF)解救治疗 40例恶性肿瘤 ,采用高效液相色谱仪 (HPLC)监测用药后 2 4h和 48hMTX的血药浓度 ,并根据血药浓度给予相应的CF解毒。结果 :40例患者零时MTX血药浓度均在 1× 10 -5mol·L-1以上 ,2 4h仍大于 1× 10 -6mol·L-1;对于 2 4h血药浓度大于 5× 10 -6mol·L-1或 48h大于 1× 10 -6mol·L-1的患者 ,可出现毒副作用 ,加大CF量后症状消失。结论 :在血药浓度监测下 。

OBJECTIVE To study the clinical significance of monitoring the serum methotrexate concentration (MTX) after administration with high dose MTX. METHODS High dose methotrexate citrovorum factor (CF) rescue was administered to 40 patients with malignant tumor. The serum MTX concentrations in 24 h and 48 h was monitored by HPLC. The dose of Cf was adjusted according to the levels of MTX in serum. RESULTS The serum concentrations of MTX at 0h in all patients were more than 1×10 -5 mol·L -1 ,and were more than 1×10 -6 mol·L -1 at 24 h. If concentration more than 5×10 -6 mol·L -1 at 24 h or more than 1×10 -6 mol·L -1 at 48 h, toxic adverse reaction may be observed in some patients. After raising the CF dose, the adverese reaction disappear.CONCLUSIONS Under serum concentration monitoring,using high dose methotrexate citrovorum factor (CF) rescue to treat malignant tumor was efficacious and safe.