1例大剂量甲氨蝶呤注射液引起严重不良反应的病例分析

Analysis of Medical Record in a Patient with High-dose Methotrexate induced Severe Adverse Reaction

患者因中枢神经系统淋巴瘤采取大剂量甲氨蝶呤(MTX)结合利昔妥单抗、阿糖胞苷及地塞米松治疗后,出现了大剂量甲氨蝶呤引起的急性肾功能不全及骨髓抑制严重不良反应。通过监测患者的MTX血药浓度、血肌酐值以及结合亚叶酸钙解救、足够碱化及水化的治疗手段,患者肾功能指标及血象恢复正常。因此,为了将MTX引起的严重不良反应程度降至最低,建议临床在甲氨蝶呤化疗后积极早期监测患者的MTX血药浓度,规范亚叶酸钙解救时间,及时碱化及水化尿液直至MTX血药浓度降至安全范围内(<0.1μmol/L)。

A patient was given high-dose methotrexate （HDMTX）plus rituximab, cytarabine and dexamethasone for the treatment of central nervous system Lymphoma, and thereafter the patient showed HDMTX-induced acute renal dysfunction, as a consequence of prolonged elimination, myelosuppression was substantially emerged. By monitoring plasma MTX concentrations and serum creatinine, using conventional treatment approaches of alkalinization, hydration and leucovorin rescue, the renal function, platelet count and white blood cell count eventually returned to baseline in the patient. Therefore, in order to reduce the incidence of the HDMTX-induced severe adverse reaction, it is critical to monitor plasma MTX concentrations as early as possible, and administrate with leucovorin, alkalinization and hydration promptly until plasma MTX concentrations reduced to a safe range（〈0.1μmol/L）.