四氢叶酸口服和注射解救豚鼠大剂量甲氨蝶呤毒性的比较  

Comparative Study on Rescue Effect of Leucovorin Per Os and Via Intramuscular in High-Dose Methotrexate Chemotherapy in Guinea Pig

作　　者：柯志勇[1] 冷静 李菁[1] 黄礼彬[1] 罗学群[1] 

机构地区：[1]中山大学附属第一医院儿科,广州510080 [2]东莞市卫生学校,广东东莞511700

出　　处：《实用儿科临床杂志》2007年第3期221-222,共2页Journal of Applied Clinical Pediatrics

摘　　要：目的比较四氢叶酸(LV)注射与口服给药解救大剂量甲氨蝶呤(HD-MTX)毒性的效果,了解口服解救安全性。方法4周龄豚鼠分成空白对照组(9只)、口服解救组和注射解救组(各18只)。空白组不用任何药物;余二组腹腔注射MTX,24h后开始喂饲(口服组)或注射(注射组)LV解救。72h后检测血清ALT和肌酐(Cr)、肝组织蛋白水平、小肠黏膜酶活性及绒毛长度。结果口服组ALT异常高值1个、Cr异常高值1个,注射组有3个和1个;二组肝组织蛋白水平无显著差异[(15.2±3.7)mg/gvs(14.9±3.5)mg/gPa>0.05)],但均高于对照组[(12.1±2.6)mg/gPa<0.05]。口服组与注射组小肠黏膜碱性磷酸酶(ALP)、γ-谷氨酰转移酶活性及绒毛长度均无显著差异[(1.302±0.691)IU/cmvs(1.073±0.465)IU/cm、(0.034±0.019)IU/cmvs(0.028±0.017)IU/cm、(400.5±80.9)μmvs(419.6±60.8)μmPa>0.05),但明显低于对照组[(4.614±1.683)IU/cm、(0.119±0.068)IU/cm和(564.2±53.8)μmPa<0.05]。结论口服给药对HD-MTX引起肝、肾及小肠黏膜毒性的解救效果并不逊于注射给药,口服解救可安全地用于HD-MTX化疗。Objective To compare the rescue effect of leucovorin taking orally with that of via intramuscular in high-dose methotrexate （HD-MTX） chemotherapy.Methods Guinea pig aged 4 weeks were divided into 3 groups：blank control （control） group （n=9）,per os （PO） group （n=18）,and intramuscular （IM） group （n=18）.Rescue with leucovorin began at 24 h after methotrexate peritoneal injection in PO group and IM group.Neither methotrexate nor leucovorin was used in control group.Serum ALT and Cr,protein content of the liver,intestinal mucosa ALP and GGT,villus length were detected at 72 h after methotrexate injection.Results One remarkable ALT value and 1 remarkable Cr value presented in PO group,3 and 1 respectively in IM group.There was no difference in liver protein content in PO group and IM group [（15.2±3.7） mg/g vs （14.9±3.5） mg/g P〉0.05）].The intestinal mucosa ALP,GGT and villus length had no significant difference in PO group and IM group [（1.302±0.691） IU/cm vs （1.073±0.465） IU/cm,（0.034±0.019） IU/cm vs（0.028±0.017） IU/cm,（400.5±80.9） μm vs （419.6±60.8） μm Pa〉0.05）],which less than in control group [（4.614±1.683） IU/cm,（0.119±0.068） IU/cm,（564.2±53.8） μm Pa〈0.05）.Conclusion The rescue effect of leucovorin per os is not inferior to via injection in les-sening the toxicity,and it can be safely used in HD-MTX chemotherapy.

关 键 词：甲氨蝶呤 四氢叶酸 解救 豚鼠 

分 类 号：R733.71[医药卫生—肿瘤]