儿童急性淋巴细胞白血病大剂量甲氨蝶呤的个体化治疗
甲氨蝶呤；血药浓度；淋巴细胞白血病；毒副反应,,],甲氨蝶呤；血药浓度；淋巴细胞白血病；毒副反应,1资料与方法,2结果,讨论,[参考文献]
[摘要] 目的 根据甲氨蝶呤(MTX)血药浓度研究探讨急性淋巴细胞白血病(ALL)治疗中MTX个体化剂量及毒副作用。方法 用不同剂量MTX治疗ALL患儿37例(83次)，荧光偏振免疫分析法测定用药后24 h和48 h血药浓度，据此调整化疗剂量及解救方案。结果 (1)24 h MTX浓度>40 μmol/L及48 h浓度>1 μmol/L，毒副作用发生率明显增高；(2)同一剂量MTX不同疗程中浓度存在明显差异。(3)83次中20次(24.1%)、37例患儿中8例(21.6%)血药浓度需经过调整方能达到安全有效浓度。结论 血药浓度监测下对ALL患儿施行MTX的个体化治疗安全、有效、经济。[关键词] 甲氨蝶呤；血药浓度；淋巴细胞白血病；毒副反应
Study on individualized chemotherapy of highdose methotrexate for children with acute lymphoblastic leukemia
LI Miao.Department of Pediatrics,Shijitan Hospital,Beijing 100038,China
[Abstract] Objective To investigate the individualized dosage and toxicity of methotrexate(MTX)in children with acute lymphoblastic leukemia(ALL)through the study of MTX serum concentration.Methods The blood concentration of MTX at 24 h and at 48 h after administration was measured by flurorescence polarization immunoassay obtained from ALL patients treated in different doses of MTX.Through which the doses of MTX and Citrovorum Factor(CF)rescue were consequently adjusted.Results (1)The occurrence of toxic sideeffects appeared with significant difference when MTX serum concentration >40 μmol/L at 24 h and >1 μmol/L at 48 h.(2)The serum concentration of MTX with same dose varied significantly in different courses.(3)About 1/4 serum concentration was not safe or effective before adjusted the doses of MTX.Conclusion The individualized chemotherapy of highdose MTX for ALL under serum concentration monitoring prove to be safe,efficacious and economical. ......
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