甲氨蝶呤治疗侵蚀性葡萄胎的血药浓度监测及不良反应观察

摘要

Objective:To investigate the necessity of monitoring methotrexate (MTX) concentration and its adverse reactions in the treatment of invasive hydatidiform mole. Methods:Ten patients diagnosed as invasive hydatidiform mole were given intramuscular methotrexate 0.4 mg·kg-1·d-1 at the same time every day for five days. Blood concentrations of methotrexate were determined at 24, 72, 120 hours after the first intramuscular injection and ADRs induced by MTX were observed. Results:After one or more cycles of treatment, nine patients were cured, one patient changed the chemotherapy due to poor efficacy. Methotrexate concentrations in thirty plasma from ten patients were lower than the safety value. ADRs occurred in six patients including one patient with severe bone marrow suppression. Conclusion:It's not necessary to monitor methotrexate blood concentration in the treatment of invasive hydatidiform mole and use calcium folinate for ADRs. Although the plasma concentration was very low, ADRs induced by methotrexate should be paid more attention to.%　　目的：探讨甲氨蝶呤治疗侵蚀性葡萄胎时,监测其血药浓度的必要性及不良反应的发生情况.方法：10例确诊为侵蚀性葡萄胎的患者,肌注甲氨蝶呤0.4 mg·kg-1·d-1,每天同一时间肌注,连续肌注5 d,并于第一次肌注后的24,72,120 h取2 mL静脉血,测定甲氨蝶呤的血药浓度,同时观察不良反应.结果：经过一个或多个周期的治疗后,9名患者治愈,1名患者由于疗效不佳,改用其他化疗方案.10例患者共30份甲氨蝶呤的血药浓度值均低于安全值；10例患者中,6例出现不良反应,其中1例患者出现严重的骨髓抑制.结论：治疗侵蚀性葡萄胎时,监测甲氨蝶呤血药浓度的意义不大,没有必要用四氢叶酸钙解毒；甲氨蝶呤的血药浓度很低时,仍然需要关注其所致的不良反应.