EMIT法监测甲氨蝶呤血药浓度在儿童恶性肿瘤和急性淋巴细胞性白血病的应用

Discussion of methotrexate therapeatic window of malignate tumor and acute lymphoblastic leukemia

目的运用均相酶扩大免疫法(EMIT)对临床使用甲氨蝶呤治疗恶性肿瘤和急性淋巴细胞性白血病患儿进行血药浓度监测,并对存在排泄延迟状况的患者进行分析和解救。方法采用EMIT法对甲氨蝶呤用药24、48、72 h血药浓度进行测定,并对其结果进行总结和分析。结果采用EMIT对47例患儿进行342例/次甲氨蝶呤血药浓度测定,除1例患儿出现排泄延迟外,其余46例患儿用药72 h均降至0.1μmol/L。342例/次血药浓度测定中C_(24h)为(48.13±31.75)μmol/L,C_(48h)为(0.48±0.93)μmol/L,C_(72h)为(0.08±0.07)μmol/L。结论临床在使用甲氨蝶呤治疗患儿时,通过对甲氨蝶呤浓度监测,观察患儿不良反应,从而确立使用CF等解救措施,是保证大剂量使用甲氨蝶呤临床安全的关键因素。

Objective The clinical use of methotrexate in the treatment of maliganant tumor and acute lymphocytic leukemia,so monitoring the concentration of methotrexate and patients with elimination delay condition analysis and rescue. Methods EMIT was used to determine the concentrations of methotrexate in 24h,48h,72h. And the results were summarized and analyzed. Results EMIT was used to monitor the concentration of methotrexate in 342 case of 47 patients. Determination of the 20 patients,only 1 patient appeared in the determination of excretion delay. Monitoring the concentration of methotrexate in 342 cases of the 24 h,48 h,72 h were （48.13 ± 31. 75 ） μmol/L, （0.48 ± 0.93 ） μmol/L, （0.08 ± 0.07 ） μmol/L. Con- dusions It is necessary to monitor the concentration of methotrexate when the patients μse methotrexate in clinic ,in order to drug safety. Adverse reactions to patients with observation time,thus timely to rescue,to ensure the safety od drug.