骨肉瘤儿童多次大剂量甲氨蝶呤化疗后出现严重消除延迟病例分析

Analysis of Severe Delayed Elimination after Multiple High-Dose Methotrexate Chemotherapy in a Child with Osteosarcoma

目的:探讨多次大剂量甲氨蝶呤(HD-MTX)化疗后出现排泄延迟的影响因素,旨在促进临床合理用药。方法:我院1例骨肉瘤患儿在多次进行HD-MTX化疗过程中出现MTX排泄异常。查阅医院电子病例系统,收集患儿各项诊疗、检查及用药资料对可能引起MTX排泄异常的相关因素进行分析。结果:该病例患儿在进行HD-MTX化疗过程中出现严重消除延迟可能与患儿的合并用药、多周期化疗等因素有关,与个体遗传基因、亚叶酸钙(CF)、MTX剂量及解救方案、尿液pH等因素可能无关。结论:同一患者在不同轮次HD-MTX化疗时,清除率有很大波动,因此每一次的化疗都应该密切关注,化疗前预处理,治疗过程中做好水化碱化、CF解救,定期监测MTX血药浓度,可减少不良反应事件的发生,同时提高疗效。

Objective:To explore the influencing factors of delayed excretion after multiple high-dose methotrexate(HD-MTX)chemotherapy,so as to promote rational clinical medication.Methods:A child with osteosarcoma had abnormal MTX excretion during multiple HD-MTX chemotherapy in our hospital.By consulting the hospital electronic medical record system,collecting the diagnosis,treatment,examination and medication information of the related factors that may cause MTX excretion abnormalities were analyzed.Results:The delayed elimination in the course of HD-MTX patients chemotherapy may be related to the combined medication and multicycle chemotherapy.It may not be related to individual genetic factors,CF,MTX dose and rescue regimen,and urine pH.Conclusion:The clearance rate of the same patient fluctuated greatly in different rounds of HD-MTX chemotherapy.Therefore,close attention should be paid to each round of chemotherapy,pre-treatment before chemotherapy,hydration and alkalization,calcium folinate rescue,regular monitoring of MTX blood concentration,so as to reduce the occurrence of adverse events and improve the treatment efficacy.