儿童急性淋巴细胞白血病化疗中甲氨蝶呤血药浓度监测结果分析  

An analysis on results of serum methotrexate concentration monitoring in children acute lymphoblastic leukemia chemotherapy

作　　者：梅艳[1] 汪洋[1] 宋新文[1] 张华年[1] 徐华[1] 

机构地区：[1]武汉市儿童医院药学部,武汉430016

出　　处：《中国临床药理学杂志》2012年第8期566-568,共3页The Chinese Journal of Clinical Pharmacology

摘　　要：目的评价儿童急性淋巴细胞白血病(ALL)化疗中甲氨蝶呤(MTX)消除的个体差异性,为临床制订合理的解救治疗方案提供依据。方法 81例ALL患儿行大剂量甲氨蝶呤(HDMTX)化疗339次,MTX剂量为3～5 g.m-2,24 h持续静脉滴注。用固相萃取高效液相色谱法测定用药后24,48,72 h血清中MTX浓度。统计各时间点浓度值,并计算变异系数(CV)。用Spearman相关分析考察48,72 h MTX血药浓度的相关性。结果 48,72 h MTX血药浓度变异系数较大,血药浓度呈正相关。结论 MTX在ALL患儿体内的消除情况存在极大的个体差异性,有必要通过血药浓度监测来指导亚叶酸钙(CF)的解救次数和剂量。Objective To inspect the individual difference of methotrexate （MTX）＇s elimination in children acute lymphoblastie leukemia （ALL） chemotherapy, and to provide the reference for determining rational saving treatment regimen in clinic. Methods Eighty - one ALL children cases received HDMTX chemotherapy 339 case times. The MTX dosage was 3 -5g. m-2 The vein drop was persistence within 24 hours. The serum concentrations of MTX were determined concomitantly by SPE - HPLC at 24, 48 and 72 h after starting MTX infusion. Concentrations of each time were put into data base and calculated their coefficient variations. The relationship of serum MTX concentrations between 48 and 72 h after starting MTX infusion was analyzed by Spearman correlation analysis method. Results There were large coefficient variations of serum MTX concentrations at 48 and 72 h after the administration, respectively. And there was positive correlation between the serum MTX concentrations at 48 and 72 h （ rs = O. 755, P 〈 0. 05 ）. Conclusion There is large individual difference of MTX elimination in children with acute lymphoblastic leukemia, so it＇s necessary to guide the use of calcium folinate with serum MTX concentration monitoring result.

关 键 词：急性淋巴细胞白血病 甲氨蝶呤 血药浓度 

分 类 号：R725.5[医药卫生—儿科] R733.71[医药卫生—临床医学]