大剂量氨甲蝶呤化疗致皮肤烫伤样损伤的临床特征及发病机制分析  

Clinic features and me chanism of scald-like skin damage induced by high-dose methotrexate

作　　者：柯志勇[1] 李斌[2] 罗学群[1] 黄礼彬[1] 刘全梁[1] 

机构地区：[1]中山大学附属第一医院儿科,广州510080 [2]中山大学附属第一医院皮肤科实验室,广州510080

出　　处：《中国医师进修杂志》2006年第1期20-21,25,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 了解大剂量氨甲蝶呤（HD-MTX）化疗引起皮肤损伤的临床特征，并探讨其发生机制。方法 总结儿童HD-MTX化疗致皮肤损伤的临床表现，并分析其发病机制。结果 皮肤损伤发生于用药后3～9d，表现为大片皮肤潮红甚至出现水疱及表皮剥脱，类似Ⅱ度烧伤，于第10～20天恢复，遗留色素沉着。症状严重者伴发热及呼吸道和消化道等器官受累。强化化疗前后大量水化等措施后皮肤损伤明显减少。结论 HD-MTX致皮肤损伤的机制在于直接的细胞毒性，并可能与排泄延迟有关。出现皮肤损伤时常伴其他系统受累，治疗上除继续大量补液、四氢叶酸解救及支持治疗外，积极抗感染治疗非常重要。Objective To study the clinic features and the mechanism of skin damage induced by high- dose methotrexate （HD- MTX）. Method Children treated with HD- MTX were enrolled in a retrospective study in which the incidence and presentations of skin damage were concluded. Mechanism of the damage was studied base on skin pathology of an animal model. Result Skin damage presented in 3-9 （median 5） days after HD-MTX and usually followed by bullation and exfoliation. Twelve cases, more severe than the others, accompanied with fever and symptoms of other organs especially the respiratory tract and the intestine. Skin damage was reduced when large dose rehydration used before, during and after HD- MTX. Conclusion FID- MTX may cause scald- like skin damage directly by its prolonged toxic effect on epidermal cells. Besides extended tetrahydrofolic acid rescue and supportive treatments, anti infection is the most important in dealing this condition.

关 键 词：氨甲蝶呤 皮肤 烫伤 

分 类 号：R730.5[医药卫生—肿瘤]