评估大剂量甲氨蝶呤治疗小儿急性淋巴细胞白血病的血药浓度与不良反应

摘要

目的：探讨采用大剂量甲氨蝶呤治疗小儿急性淋巴细胞白血病时血药浓度与不良反应的相关性。方法随机选取2014年1月至2015年9月急性淋巴细胞白血病患儿35例，所有患儿均接受大剂量甲氨蝶呤治疗，并采用酶放大免疫法对给药后患儿的血药浓度进行测定，同时对其不良反应进行观察。结果非排泄延迟组患儿的48 h 血药浓度及解救次数均明显优于排泄延迟组，差异有统计学意义（P <0.05）；对于 B 系患儿，血药浓度≥1.6μmol/ L 组患儿其黏膜损害、胃肠道反应及肾功能损害发生率均显著高于血药浓度<1.6μmol/ L 组；对于T 系患儿而言，血药浓度≥1.6μmol/ L 组患儿其呼吸道反应、肾功能损害发生率显著高于血药浓度<1.6μmol/ L组，差异有统计学意义（P <0.05）。结论在采用大剂量甲氨蝶呤治疗小儿急性淋巴细胞白血病时，血药浓度同排泄延迟、不良反应的发生情况之间存在密切联系，通过对患儿血药浓度进行监测，可为临床解救方案的制定提供可靠依据，有利于促进患儿生存质量的改善。%Objective To investigate the correlation between serum concentration and adverse drug reaction in children with acute lymphoblastic leukemia treated with high dose methotrexate. Methods Thirty-five cases of children with acute lymphoblastic leukemia were randomly selected from January 2014 to September 2015,all patients were treated with high dose methotrexate,and by enzyme amplified immu-noassay for serum concentration of patients after administration of determination,the incidence of adverse reaction were observed. Results Non elimination delay group with 48 hours of blood drug concentration and the number of rescue were significantly better than the elimination delay group,the difference was sta-tistically significant(P <0. 05);for B patients,in serum concentration ≥1. 6 μmol/ L group,the mucosal damage,gastrointestinal reaction and renal function damage rate was significantly higher than that of the blood concentration < 1. 6 μmol/ L group;for T patients,in the blood concentration ≥1. 6 μmol/ L group,the respiratory tract reaction,the incidence of renal impairment was significantly higher than the blood concentration < 1. 6 μmol/ L group,the difference was statistically significant( P < 0. 05 ). Conclusions High-dose methotrexate in the treatment of children with acute lymphoblastic leukemia, there is a close correlation between blood concentration with delayed excretion,adverse reaction conditions, through the monitoring of blood drug concentration,which can provide a reliable basis for clinical rescue plan,and it is conducive to the promotion of the quality of life improvement in children.