基于基因多态性和血药浓度对甲氨蝶呤个体化药学服务模式的探讨

Exploration of an Individualized Pharmacy Service Model for Methotrexate Based on Genetic Polymorphisms and Blood Concentration

目的探讨精准化药学服务的形式下,如何分析甲氨蝶呤血药浓度检测与基因多态性对急性淋巴细胞白血病患者大剂量甲氨蝶呤化疗的影响和意义。方法回顾性分析2022年4月滨州医学院附属医院1例发生甲氨蝶呤延迟排泄合并急性肾损伤的急性淋巴细胞性白血病患者,通过对其合并用药,分析多个基因位点的多态性,以及血液净化方案的选择,探讨影响甲氨蝶呤清除的相关因素以及应对措施。结果分析该患者血药浓度与不良反应之间的相关性,以及基因多态性对患者血药浓度的影响,结合药物管理理念,构建个体化药学服务模式。对本院急性淋巴细胞白血病患者提供个体化药学服务。结论临床药师全面参与急性淋巴细胞白血病患者治疗管理可有效提高对患者服务的质量。

Objective To explore how to analyze the impact and significance of methotrexate blood concentration test-ing and gene polymorphism on high-dose methotrexate chemotherapy for patients with acute lymphoblastic leukemia in the form of precision pharmacy service.Methods Retrospectively analyzed a case of acute lymphoblastic leukemia patient who occurred delayed excretion of methotrexate combined with acute kidney injury in the Affiliated Hospital of Binzhou Medical College in April 2022,and explored the relevant factors affecting methotrexate clearance as well as countermeasures by combining the medication with the drug,analyzing polymorphisms of multiple gene loci,and the selection of blood purification regimen.Results The correlation between blood drug concentration and adverse reac-tions in this patient was analyzed,as well as the influence of gene polymorphisms on the patient's blood drug concen-tration,which was combined with the concept of drug management to construct an individualized pharmacy service model.Individualized pharmacy service was provided to our acute lymphoblastic leukemia patients.Conclusion The comprehensive participation of clinical pharmacists in the therapeutic management of patients with acute lymphoblas-tic leukemia can effectively improve the quality of services to patients.