不同剂量甲氨蝶呤治疗急性淋巴细胞白血病的毒性分析

Safety of Different Doses of Methotrexate in the Treatment of Acute Leukemia

目的对不同剂量甲氨蝶呤治疗急性淋巴细胞白血病的毒性进行回顾性分析。方法方便选取2016年1月-2019年1月在该院接受治疗的40例急性淋巴细胞白血病患者为研究对象,根据患者疾病的危险度进行分组,分为中高危组和标危组。对标危组的19例患者治疗方法为化疗给予甲氨蝶呤3.0 g/m^2;对中高危组的21例患者的治疗方法为化疗给予甲氨蝶呤5.0 g/m^2;对两组患者治疗后的48 h的血药浓度及治疗毒性发生率进行回顾性分析。结果标危组患者在48 h后检测血药浓度低于1μmol/L的有14例,中高危组患者中有12例,差异无统计学意义(χ~2=0.234,P>0.05);对两组患者的治疗毒性进行比较,包括治疗之后的肝功能损害、发热、胃肠道反应、骨髓抑制等,发现甲氨蝶呤标危组的治疗相关毒性较中高危组稍高,差异无统计学意义(χ~2=0.365、0.134、0.432、0.425,P>0.05)。结论不同剂量甲氨蝶呤对于急性淋巴细胞白血病患者的治疗毒性没有差异。在临床应用中,要根据患者疾病的危险程度选择不同的剂量,将甲氨蝶呤在急性淋巴细胞白血病治疗中的重要作用发挥出来。

Objective To investigate the safety of different doses of methotrexate in the treatment of acute leukemia.Methods Fourty patients with acute leukemia who were treated in the hospital from January 2016 to January 2019 were convenienty enrolled. The patients were divided into middle-high risk group and standard risk group according to the risk of disease. example. The treatment of 19 patients in the standard-risk group was given methotrexate 3.0 g/m^2 after chemotherapy;21 patients in the middle-high-risk group were treated with methotrexate 5.0 g/m^2 after chemotherapy;The blood concentration of the two groups of patients after 48 h of treatment was compared, and the incidence of adverse reactions was compared between the two groups. Results There were 14 patients with standard blood group concentration lower than 1μmol/L after 48 h, and 12 patients with moderate to high risk group, the difference was not statistically significant(χ~2=0.234,P>0.05);the treatment toxicity of the two groups of patients Comparisons, including liver damage, fever,gastrointestinal reactions, myelosuppression after treatment, were found to be slightly higher in the treatment-related toxicity of the methotrexate standard blood group than in the moderal be to high Tisk group, respectively, and the difference was not statistically significant(χ~2=0.365, 0.134, 0.432, 0.425,P>0.05). Conclusion The incidence of adverse reactions in patients has no correlation with the concentration of methotrexate, but can cause different degrees of adverse reactions. In clinical applications, different doses should be selected according to the degree of risk of the patient’s disease, and the important role of methotrexate in the treatment of leukemia should be exerted.