摘要
目的通过监测甲氨蝶呤血药浓度指导急性淋巴细胞白血病(ALL)患者的大剂量甲氨蝶呤(HD-MTX)化疗和解救方案,保证用药合理、有效、安全。方法 1将30例次HD-MTX化疗的ALL患者按甲氨蝶呤剂量不同分组,每组15例次,Ⅰ组3g/m2,Ⅱ组5g/m2。用高效液相色谱法(HPLC法)测定化疗结束后0、20、44h(必要时追加68h、92h采血点)所测得的血药浓度监测,指导亚叶酸钙(CF)解救,同时观察患者不良反应和Ⅰ组、Ⅱ组两组化疗前后患者肝肾功能各项指标的变化。2按照1中HPLC法所测得的甲氨蝶呤血药浓度将30例ALL患者分为排泄延迟组和非排泄延迟组,并分析甲氨蝶呤排泄延迟与不良反应之间的联系。结果 1于0、20和44h时,高剂量Ⅱ组的血药浓度均比低剂量Ⅰ组血药浓度高。相应的是,高剂量Ⅱ组各种不良反应发生率也较低剂量Ⅰ组高;2排泄延迟组肝肾功能异常的比例明显比非排泄延迟组高。结论甲氨蝶呤的血药浓度监测可提高治疗用药安全性和有效性,对CF个体化解救、减少不良反应的发生具有十分重要的意义。
OBJECTIVE To ensure the use of medication reasonable,offective and safe by therapeutic drug monitoring of high-dose methotrexate in pediatric acute lymphoblastic leukemia and assessing the clinical significance. METHODS （1）30 acute lymphoblastic leukemia patients were grouped according to the dosage of methotrexate：the high dosage group received MTX 5.0g/m2 and the low dosage group received MTX 3, 0g/m2. The MTX concentration in serum at 0,20,44（68h ,92h p. r. n） were detected by high performance liquid chromatography（HPLC） . Then adjust the dosage of CF according to MTX concentration and observe the adverse effects of MTX in patients. （2） patients were grouped elimination delay group and no-elimination delay group according to MTX concentration by high performance liquid chromatography（HPLC） from（1）, then analyze the relationship between elimination delay of methotrexate and adverse reaction. RESULTS （1）The concentration of MTX at 20,44 of high dosage group were higher than the concentration of MTX at 20,44 of low dosage group, respectively. And, the occurrence of adverse reactions of high dosage group is also higher than low dosage group ; （2）The proportion of abnormity of hepatorenal function in elimination delay group is obviously higher than no-eliminati0n delay group. CONCLUSION To Monitoring the concentration of MTX can enhance safety and effectiveness of medication use, which has clinical significance. For CF individual rescueing and the occurrence of adverse reactions reducing.
出处
《海峡药学》
2014年第7期170-172,共3页
Strait Pharmaceutical Journal
