高甲氨蝶呤血症的血液净化治疗

Blood purification therapies of hypermethotrexemia

大剂量甲氨蝶呤(MTX)常用于治疗白血病和恶性淋巴瘤等。但因此会带来急性肾损伤、骨髓抑制、黏膜炎等严重不良反应。MTX中毒风险高的患儿在水化碱化及高剂量亚叶酸解救基础上,需尽早行血液净化清除MTX。应根据患儿全身状况、肾损伤程度及MTX浓度决定血液透析的次数和频率,有条件时可选择高通量血液透析。持续肾替代疗法(CRRT)适合于血流动力学不稳定患儿。当MTX浓度极高时,建议联合血液灌流和血液透析以达到更好的清除效果。

Methotrexate (MTX) is administered at a high dose for the treatment of diseases such as leukemia and malignant lymphoma.However, it will cause serious adverse reactions such as acute kidney injury, myelosuppression, and mucositis.On the basis of hydration alkalization and high-dose leucovorin rescue in children with high risk of MTX poisoning, blood purification should be performed as soon as possible to clear MTX.The number and frequency of hemodialysis should be determined according to the general condition of the child, the degree of renal injury and the concentration of MTX, and high-throughput hemodialysis can be selected if available.Continuous renal replacement therapy is suitable for children with hemodynamic instability.When the MTX concentration is extremely high, it is recommended to combine hemoperfusion and hemodialysis to achieve better clearance.