大剂量甲氨蝶呤治疗淋巴系统肿瘤的药物不良反应影响因素分析

Analysis of influencing factors on the drugs adverse reactions of high dose methotrexate in the treatment of patients with lymphatic tumors

目的探讨大剂量甲氨蝶呤(HD-MTX)化疗后药物不良反应的影响因素,为实现甲氨蝶呤个体化用药提供依据。方法收集2014年6月至2016年12月新疆医科大学第一附属医院血液病中心及儿科中心147例淋巴系统恶性肿瘤患者的临床病例,记录患者用HD-MTX化疗前后的相关信息,用单因素法分析患者使用HD-MTX化疗后药物不良反应的影响因素。结果影响药物不良反应的因素包括民族、年龄、联合化疗、疗程数、化疗前血小板(PLT)、化疗前谷丙转氨酶(ALT)、化疗前谷草转氨酶(AST)、体重指数(BMI)、体表面积和甲氨蝶呤给药剂量(P<0.05)。骨髓抑制发生情况:化疗前PLT异常的患者高于化疗前PLT正常的患者,体表面积大的患者高于体表面积小的患者;肝功能损伤发生情况:儿童患者高于成人患者,单用HD-MTX化疗患者高于联合化疗患者,化疗3次以上的患者高于化疗2次以下的患者,化疗前肝功能异常患者高于化疗前肝功能正常患者,体表面积小的患者高于体表面积大的患者,甲氨蝶呤给药剂量大的患者高于甲氨蝶呤给药剂量小的患者;急性肾损伤发生情况:汉族患者高于维吾尔族患者,成人患者高于儿童患者,BMI大的患者高于BMI小的患者,体表面积大的患者高于体表面积小的患者。结论临床使用HD-MTX时,应对患者的民族、年龄、体表面积、BMI、联合化疗、疗程数、给药剂量、化疗前肝功能和血常规等影响因素多加关注,以降低药物不良反应的发生率。

Objective To investigate the influencing factors of adverse drug reactions after high-dose methotrexate（HD-MTX） chemotherapy,and to provide evidence for personalized medicine of methotrexate.Methods Clinical cases of 147 patients with lymphatic cancer were collected from June 2014 to December 2016 in hematology center and pediatric center of the First Affiliated Hospital of Xinjiang Medical University,the information of patients before and after chemotherapy were recorded,and then analyzed the influencing factors of adverse drug reactions by method of single factor.Results Factors that affected adverse drug reactions included ethnic,age,the number of courses,combined with chemotherapy,the number of platelet（PLT）,alanine aminotransferase（ALT） and aspartate transaminase（AST） before chemotherapy,body mass index（BMI）,body surface area and dosage of methotrexate（P 〈 0.05）.The incidence of myelosuppression： Patientswith abnormal PLT before chemotherapy was higher than normal ones,the large body surface area were higher than small body surface area.The incidence of hepatic injury： child patients were higher than adults,patients with single HD-MTX chemotherapy were higher than combined chemotherapy,patients who received chemotherapy more than 3 courses were higher than those less than 2 courses,the abnormal liver function before chemotherapy were higher than normal the ones,the small body surface area were higher than the large body surface area,the high dose MTX were higher than low dose MTX.The incidence of acute renal impair： Han patients were higher than Uyghur,adult were higher than children,the large BMI were higher than small BMI,the large body surface area were higher than small ones.Conclusion When use HD-MTX in clinic,we should pay more attention to the factors that ethnic,age,body surface area,BMI,combined with chemotherapy,the number of courses,dosage of methotrexate,chemotherapy before liver function or blood routine,and to decrease the incidence of adverse drug reactions.