1例急性淋巴细胞白血病患儿大剂量甲氨蝶呤化疗后出现消除延迟异常合并急性肾损伤病例分析

Analysis of a Case of Children with Acute Lymphoblastic Leukemia with Delayed Elimination and Acute Kidney Injury after High-dose Methotrexate Chemotherapy

目的:探究分析1例急性淋巴细胞白血病(ALL)患儿大剂量甲氨蝶呤(HDMTX)化疗后出现消除延迟异常合并急性肾损伤的影响因素,以期促进临床合理用药。方法:1例ALL患儿在行HDMTX化疗过程中出现甲氨蝶呤(MTX)排泄异常合并急性肾损伤。通过查阅医院电子病例系统,收集患儿各项诊疗、检查及用药资料;采用荧光原位杂交技术对MTX相关基因突变位点进行基因分型检测,对可能引起MTX排泄异常的相关因素进行分析。结果:患儿在进行HDMTX化疗过程中出现消除延迟异常及急性肾损伤,可能与患儿的水化碱化量、药物代谢酶等因素有关。结论:宜在ALL患儿行HDMTX化疗前对药物代谢MTX进行基因检测,根据患者基因型制定个体化治疗方案,并在化疗过程中及时监测MTX血药浓度,患儿的肝肾功能及影响MTX排泄的多种因素,从而提高疗效,减少毒副反应的发生。

Objective:To explore and analyze the influencing factors of delayed elimination combined with acute kidney injury after high-dose methotrexate(HDMTX)chemotherapy on a case of children with acute lymphoblastic leukemia(ALL),so as to promote rational clinical medication.Methods:1 case of children with ALL occured delayed elimination of MTX combined with acute kidney injury in the course of HDMTX chemotherapy.By consulting the hospital electronic medical record system,collecting information about the diagnosis,treatment,examination and medication of the pationt,using fluorescence in situ hybridization for genotyping of methotrexate related gene mutation sites,and analyzed the related factors that may cause MTX excretion abnormalities.Results:The delayed elimination and acute kidney injury in the course of HDMTX chemotherapy may be related to the amount of hydration urine alkalization,drug metabolism enzymes and other factors.Conclusion:The genotype of MTX should be detected before HDMTX chemotherapy in ALL children,and individualized treatment plan should be made according to the genotype of patients,and MTX blood concentrations,liver and kidney functions of the patients and other factors affecting MTX excretion should be timely monitored during chemotherapy,so as to improve the efficacy and reduce the occurrence of toxic and side effects of MTX.