大剂量氨甲蝶呤治疗小儿急性淋巴细胞白血病水化和碱化方法的探讨  

Comparative study on two different ways of hydration and alkalization in the treatment of childhood acute lymphoblastic leukemia with high-dose methotrexate.

作　　者：刘安生 高英[2] 薛惠良[1] 王耀平[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心血液肿瘤科 [2]沈阳市妇婴医院新生儿科,110014

出　　处：《中国实用儿科杂志》2005年第6期354-356,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨进一步降低大剂量氨甲蝶呤(HDMTX)治疗小儿急性淋巴细胞白血病(ALL)毒副反应的方法。方法对2000年1月至2001年12月在上海儿童医学中心血液肿瘤科住院治疗的47例ALL患儿共进行的134例次HDMTX治疗,按照两种不同的水化、碱化方法,分为全国标准治疗组和观察组。观察患儿血清中的MTX浓度、治疗效果及毒副反应的发生率。结果(1)按WHO相关分度标准,各种毒副反应的发生率、Ⅲ度或Ⅲ度以上的毒副作用者的发生率两组比较差异有显著性意义。(2)观察组有2例次出现尿素氮的升高,标准治疗组未出现。(3)在应用HDMTX开始后44h、68h时血清MTX浓度异常者两组相比较差异有显著性意义。结论观察组HDMTX的毒副反应发生率及严重程度均明显低于全国标准治疗组,且减少治疗费用,而不影响HDMTX治疗效果。Objective To study the ways to further reduce the toxic side-effects of the HD-MTX in the treatment of childhood acute lymphoblastic leukemia.Methods The patients were divided into two groups:the testing and the treatment group.Two different ways of hydration and alkalization were used in the course of HD-MTX to evaluate the treatment results.Monitor the dynamic changes of the serum MTX level and occurrence of the toxic side-effects.Results The results showed:(1)comparing the above toxic side-effects occurred in both groups,significant difference could be found;(2)blood urea nitrogen(BUN) increased in 2 cases in the testing group but no one happened in the treatment group;(3)the occurrence of the serum MTX level abnormalities after 44 and 68 hours of HD-MTX treatment appeared in both groups with significant difference.Conclusion It shows the protocol for hydration and alkalization in the testing group has greater advantage than that in the treatment group in reducing the toxic side-effects.This may decrease the cost of treatment,but may not influence the treatment effect of HD-MTX.

关 键 词：氨甲蝶呤 白血病 淋巴细胞 急性 副反应 

分 类 号：R72[医药卫生—儿科]