成人大剂量甲氨蝶呤治疗后排泄延迟因素的分析

Elimination delay after the treatment with high dosemethotrexate in adults

目的通过对接受大剂量甲氨蝶呤(HD-MTX)化疗患者血药浓度及尿常规和肾功能等指标进行监测,分析MTX排泄延迟的影响因素,为指导HD-MTX化疗提供参考。方法对2008年9月-2013年7月136例次接受HD-MTX化疗患者的血清药物浓度、尿pH值和肾功能进行监测,并对可能的相关因素进行统计学分析。结果共检测MTX血药浓度214次,发生排泄延迟共41次(30.1%),43例患者在治疗中发生1次排泄延迟的有11例,发生2次排泄延迟的有7例,发生3次以上排泄延迟的有4例。排泄延迟的危险因素有MTX的用量、开始化疗后24h尿常规pH值,14例次开始化疗后24h尿常规pH为7.5,均未发生排泄延迟。结论在HD-MTX治疗后,在进行亚叶酸钙(CF)解救的同时要配合好碱化和水化,也要对患者血清MTX浓度、尿PH值和肾功能进行监测,发生排泄延迟时及时调整CF解救剂量并加强碱化和水化可减少不良反应发生,必要时需行血液透析。

[ Objective ] To monitor the blood concentration,urine routine and renal function of patients treated with high dose-methotrexate, analyze the influential factor of MTX delayed excretion and provide a reference for HD-MTX chemotherapy. [Methods] A total of 136 patients underwent HD-MTX chemotherapy from September 2008 to July 2013 were selected. The serum drug concentration, urine pH value and renal function were monitored, and the correlation factors were analyzed statistically. [Results] In the 214 blood concentrations of MTX , there were 41 delayed excretions （30.1%）. Among 43 patients, 11 patients oeeured delayed excretion once, 7 patients oceured delayed excretion twice, and 4 patients oecured delayed excretion more than 3 times. The dose of MTX and urine pH value at 24h after chemotherapy were the risk factors of delayed excretion. No delayed excretion was found in 14 patients whose urine PH values at 24h after chemotherapy were 7.5. [Conclusions] After HD-MTX therapy, calcium folinate rescue should be performed, alkalization and hydration should be given at the same time, and MTX concentration, urine PH value and renal function should be monitored. When the delayed excretion happens, we should regulate the dose of calcium folinate, strengthen the alkalization and hydration to reduce untoward effect, and conduct hemodialysis if necessary.