口服小剂量甲氨蝶呤导致全血细胞减少临床分析

Pancytopenia secondary to oral low dose methotrexate therapy in 10 patients

目的:了解口服小剂量甲氨蝶呤导致的全血细胞减少患者的临床特点及治疗。方法:回顾性分析本院10例小剂量甲氨蝶呤导致的全血细胞减少患者临床资料。结果:10例患者中,8例服用MTX总量≤30mg,10例均出现口腔粘膜溃烂或出血,发热6例,皮肤瘀点瘀斑6例,肺部感染5例,腹痛、腹泻4例,消化道出血2例,肾功能损害4例,肝功能损害2例。4例患者死亡,死亡原因为:感染性休克及多脏器功能衰竭。结论:小剂量甲氨蝶呤导致的全血细胞减少应引起临床重视。

Objective:To investigate the clinical features of patients who had pancytopenia secondary to oral low dose methotrexate.Methods:Ten patients who had pancytopenia secondary to oral low dose methotrexate were registered in the department. Their clinical data were assessed.Results:A total of 10 patients with pancytopenia related to MTX therapy were dentified, six of 10 patients were moderate or severe pancytopenia.The total dose of MTX was less than 30 milligram in eight of 10 patients. Oral mucositis or bleeding was presented in all patients.Six patients had fever.There were petechia in 6 patients,pneumonia(5), abdominal pain and diarrhea(4),digestive tract bleeding(2),renal impairment(4) and abnormal liver function(2).Four of 10 patients died,the causes of death were septic shock and poly-organ failure. Conclusion:Pancytopenia is a serious side effect of low dose MTX therapy and should pay more attention to it.