血液透析治疗大剂量甲氨蝶呤化疗所致急性肾损伤的疗效  

Therapeutic Effect of Hemodialysis on Acute Kidney Injury Induced by High-Dose Methotrexate Chemotherapy in Children

作　　者：李迪[1] 李晓忠[1] 

机构地区：[1]苏州大学附属儿童医院肾脏科,江苏苏州215003

出　　处：《实用儿科临床杂志》2012年第17期1320-1322,共3页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(30972711)

摘　　要：目的观察血液透析治疗大剂量甲氨蝶呤(HD-MTX)化疗所致急性肾损伤(AKI)的临床疗效。方法回顾性分析2008年5月-2012年1月在苏州大学附属儿童医院HD-MTX化疗后致AKI的8例ALL患儿的临床资料。患儿均在常规治疗(增加亚叶酸钙解救量及次数,使用止吐、保肝、黏膜保护等药物及充分水化、碱化)的基础上联合血液透析,比较血液透析前后患儿肝肾功能、MTX血药质量浓度、电解质等血液学指标的变化。结果 1.HD-MTX化疗致AKI患儿血液透析后肾功能均恢复正常,血肌酐、尿酸、尿素值显著降低,差异均有统计学意义(Pa<0.01);肾功能恢复正常的时间为(7.00±3.74)d,透析次数为(3.13±1.13)次。2.血液透析后血MTX水平的降低有统计学意义(P<0.05),MTX血药质量浓度降低至正常的时间为(5.75±1.75)d。3.透析前后患儿血WBC、PLT、Hb的减低有统计学意义(Pa<0.05)。4.患儿LDH、血钠离子、钾离子、氯离子、钙离子水平、实际碳酸氢盐、标准碳酸氢盐、ALT、AST及血液pH水平在透析前后的变化均无统计学意义(Pa>0.05)。结论血液透析能有效治疗HD-MTX化疗导致的AKI,并清除患儿体内的MTX。Objective To observe the curative effect of hemodialysis on acute kidney injury（AKI） induced by high-dose methotrexate（HD-MTX） chemotherapy. Methods Clinical data of 8 patients who suffered from AKI induced by HD-MTX during the treatment of acute lymphocytic leukemia between May 2008 and Jan.2012 in Children′s Hospital Affiliated to Soochow University were analyzed and studied retrospectively.All patients were remedied by hemodialysis based on conventional therapies：increasing the dosage of calcium folinate,sufficient hydration and urinary alkalization,using antiemetic and hepatoprotective as well as mucosal protective drug.The changes of renal function,blood drug level of MTX,water-electrolyte and hepatic function before and after hemodialysis were compared. Results 1.The renal function of 8 patients completely recovered after hemodialysis in（7.00±3.74） days,and the average dialysis frequency was（3.13±1.13） courses,so the decrease of serum creatinine,blood uric acid,blood urea after high-flux hemodialysis had statistical significances（Pa〈0.01）.2.The reduction of blood drug level of MTX was statistically significant（P〈0.05）,and proper MTX excretion achieved in（5.75±1.75） days.3.After hemodialysis,the numbers of white blood cell,platelet,and hemoglobin decreased significantly（Pa〈0.05）.4.The concentration of lactate dehydrogenase,sodion,kalium ion,chloridion,calcium ion,actual bicarbonate,standard bicarbonate,alanine aminotransferase,aspartate aminotransferase and potential of hydrogen changed unnoticeably and were of no significant differences（Pa〉0.05）. Conclusion Sufficient hemodialysis has effect on the recovery of AKI and the reduction of blood drug level of MTX.

关 键 词：血液透析 甲氨蝶呤 急性肾损伤 

分 类 号：R733.7[医药卫生—肿瘤]