14例老年类风湿关节炎患者甲氨蝶呤中毒临床特点及中毒原因探讨

摘要

Objective:To investigate clinical features and causes of methotrexate(MTX) intoxication in the treatment of rheumatoid arthritis(RA) in elderly patients.Methods:Retrospective analysis regarding the clinical information and treatment procedures was performed in 14 RA cases complicated with intoxication in MTX medication.Results:The toxicity was associated with misuse of methotrexate in the 14 patients,and with injuries of skin mucous membrane in 14 cases and hemorrhage of digestive tract in 5,renal damage in 6.Certain degree of cytopenia occurred the total 14 patients.Circumvent measures included use of calcium folinate,infection control,stimulating bone marrow using colony-stimulating factor,transfusion of blood product,liver pro-tection and comprehensive nursing.Nine patients were recovered and discharged,and deaths occurred in hospital.Another 2 patients were referred to the other institutions and cured.Conclusion:Clinically,toxicity from methotrexate is commonly characterized by acute bone marrow suppression,ulceration of the skin and mucous membranes as well as liver and kidney dysfunction.The causes for death of elderly patients with RA treated with this agent are associ-ated with infection and heart failure.Patients with lower educational background and poor patient-doctor communication are attributable to the common cau-ses of MTX intoxication.However,the therapeutic effect can be good in some patients if given rational treatment.Physicians should be alert to the adverse e-vent,because MTX can be higher death risks in treatment of RA in elderly patients.%目的:探讨老年类风湿关节炎患者甲氨蝶呤(MTX)中毒临床特点及其中毒原因.方法:回顾分析14例MTX治疗老年类风湿关节炎患者引起中毒的临床资料、诊治经过.结果:14例MTX中毒患者均为错误服用MTX;14例患者均出现皮肤黏膜损害,5例患者出现消化道出血,6例肾功能损害;14例患者均出现不同程度血细胞减少;治疗给予亚叶酸钙解救、抗感染、应用血细胞集落刺激因子刺激骨髓造血、成分输血、保肝及加强基础护理等综合救治措施.9例患者康复出院,3例患者死亡,2例转外院治疗康复出院.结论:急性骨髓抑制,皮肤、黏膜溃烂,肝肾功能损害是MTX中毒常见的临床表现.感染、心功能衰竭是老年类风湿关节炎患者MTX中毒死亡原因.低文化水平、医患沟通不良及无医师指导服药导致的误服是MTX中毒的常见原因.部分患者及时、合理治疗能取得满意疗效.老年类风湿关节炎患者MTX中毒死亡风险高,临床上应该提高警惕.