超剂量甲氨蝶呤致类风湿关节炎患者血常规三系减少

Reduced blood cells of three lines on routine blood test induced by overdose of methotrexate in a patient with rheumatoid arthritis

1例73岁女性类风湿关节炎患者自行将甲氨蝶呤剂量从5 mg、1次/周改为2.5 mg、1次/ d，14 d 后唇部及口腔黏膜出现多发溃疡伴剧烈疼痛及口干，第15天遵外院医嘱停药。停药后第7天实验室检查示 WBC 0.6×109/ L，Hb 79 g/ L，PLT 7×109/ L，ALT 169 U/ L，AST 96 U/ L，γ-GT 72 U/ L。考虑系超剂量甲氨蝶呤致血常规三系减少。先后给予甲泼尼龙琥珀酸钠40 mg、1次/ d 静脉滴注，0.9%氯化钠注射液100 ml ＋盐酸利多卡因注射液漱口，皮下注射重组人粒细胞刺激因子300 U，静脉滴注病毒灭活冰冻血浆225 ml 及单采血小板1个单位，辅以护肝、护胃、补铁、补钙等对症治疗。治疗12 d 后复查，WBC 8.0×109/ L，Hb 81 g/ L，PLT 208×109/ L，ALT 19 U/ L，AST 22 U/ L，γ-GT 41 U/ L。

A 73-year-old female changed the dosage of methotrexate from 5. 0 mg once a week to 2. 5 mg once daily for 14 days. She developed multiple ulcers in lip and oral mucosa,severe pain and dry mouth. On day 15 she discontinued methotrexate according to the doctor＇s advice of another hospital. The results of laboratory test on 7 days after drug withdrawal showed the following values：WBC 0. 6 × 109 / L,Hb 79 g/ L,PLT 7 × 109 / L,ALT 169 U/ L,AST 96 U/ L,γ-GT 72 U/ L. The patient was diagnosed as reduced blood cells of three lines induced by overdose of methotrexate. She received IV infusion of methylprednisolone 40 mg once daily,rinsed the mouth by 0. 9% sodium chloride injection 100 ml plus lidocaine hydrochloride injection 10-20 ml,hypodermic injection of recombinant human granulocyte colony stimulating factor 300 U,IV infusion of virus inactivated frozen plasma 225 ml and apheresis platelets 1 U successively. At the same time she received the symptomatic treatment including liver-protection,stomach-protection,iron supplement,and calcium supplement. The results of laboratory test on 12 days after the above-mentioned treatment showed the following values：WBC 8. 0 × 109 / L,Hb 81 g/ L,PLT 208 × 109 / L, ALT 19 U/ L,AST 22 U/ L,γ-GT 41 U/ L.