大剂量甲氨蝶呤不同给药持续时间治疗原发性中枢神经系统淋巴瘤的研究

目的研究大剂量甲氨蝶呤(HD-MTX)不同给药持续时间治疗原发性中枢神经系统淋巴瘤对患者脑脊液中药物浓度的影响。方法采用自身对照法比较HD-MTX快速滴注(3 h)与常规滴注(6 h)对患者脑脊液中MTX浓度的影响;利用反相高效液相色谱法检测MTX浓度;对不同测量时间点两种给药方式的脑脊液药物浓度进行配对t检验,分析脑脊液药物浓度与血药浓度的相关性。结果HD-MTX快速滴注(3 h)与常规滴注(6 h)给药后第3 h(6.56μmol·L-1 vs.4.40μmol·L-1,P=0.017)、6 h(7.53μmol·L-1 vs.5.03μmol·L-1,P<0.001)、12 h(2.27μmol·L-1 vs.0.63μmol·L-1,P=0.005),患者脑脊液中的药物浓度有显著差异;常规滴注后第12 h,患者脑脊液中的MTX浓度(0.63±0.33)μmol·L-1低于有效治疗浓度,而快速滴注后12 h的浓度(2.27±0.70)μmol·L-1仍维持在有效治疗浓度;患者血药浓度与脑脊液药物浓度无明显相关性(r=0.221)。结论HD-MTX快速滴注(3 h)相比常规滴注(6 h)可显著提高原发性中枢神经系统淋巴瘤患者脑脊液中的MTX浓度,延长药物有效作用时间,且患者耐受良好。

Thirty-two Cases of Vascular Headache Treated by Acupuncture Combined with Chinese Herbal Decoction

To compare the acupuncture plus oral administration of Chinese herbal decoction with simple oral administration of Chinese herbal decoction in the treatment of vascular headache. Methods： Sixty two patients were randomly divided into a treatment group （32 cases） and a control group （30 cases）. Acupuncture at Baihui （GV 20）, Fengchi （GB 20）, Shuaigu （GB 8）, Xingjian （LR 2）, Neiguan （PC 6）, Sanyinjiao （SP 6） and Ashi points combined with oral administration of Chinese herbal decoction, was applied in the treatment group, and simple oral administration of Chinese herbal decoction was applied in the control group. Results： The total therapeutic effect in the treatment group was better than that in the control group （P〈0.05）. After treatment, the frequency, and duration of the attacks were reduced and shortened, and headache greatly alleviated in both groups （P〈0.01）. The alleviation in the treatment group was more obvious than that in the control group （P〈0.05）. Conclusion： Acupuncture combined with oral administration of Chinese herbal decoction provided remarkable therapeutic effects in treating vascular headache.