动态监测甲氨蝶呤血药浓度在治疗儿童急性淋巴细胞白血病的意义  

Clinical significance on monitoring the blood concentration of MTX in the treatment of children with acute lymphoblastic leukemia

作　　者：宋晓勇[1] 张永州[1] 杨柳[2] 吴先闯[1] 

机构地区：[1]河南大学淮河医院药剂科,河南开封475000 [2]河南大学淮河医院血液科,河南开封475000

出　　处：《中国医院药学杂志》2012年第24期1986-1988,共3页Chinese Journal of Hospital Pharmacy

摘　　要：目的:对急性淋巴细胞白血病(ALL)患儿采用大剂量甲氨蝶呤(MTX)与亚叶酸钙(CF)解救疗法过程中MTX血药浓度进行动态监测,以保证MTX血药浓度在整个化疗过程中处于合适的治疗浓度。方法:收集某院2010年11月-2011年12月血液肿瘤科确诊为ALL患儿18例,按临床分型分为标危组、中危组、高危组,采用大剂量(3～5g.m-2)MTX化疗,采用酶放大免疫法(EMIT)测定用药后24,44,68h血清中MTX浓度,并以测定结果为依据调整解救剂量和解救次数。结果:E-MIT法测定血清MTX浓度快速、准确,可及时调整解救药物的给药剂量和频次,其中标危组、中危组、高危组使用CF解救的剂量分别为:(47.6±50.9),(150.0±114.2),(211.8±151.7)mg。结论:对大剂量MTX化疗患儿进行血药浓度动态监测有利于及时调整解救药物的剂量和给药频次,及时采取解救措施,可大大减小大剂量MTX化疗的危险性,使患儿顺利通过大剂量甲氨蝶呤治疗,按期化疗。OBJECTIVE To monitor the serum drug concentrations and study the elimination characteristics of high dose MTX chemotherapy in the treatment of children with acute lymphoblastic leukemia. METHODS 18 acute lymphoblastic leuke- mia children from Nov. 2010 to Dec. 20l1 were grouped according to the risk factor, the standard risk group, middle and high risk group received MTX （3 to 5 g.m-2 ）. EMIT assay was developed to determine the serum MTX concentrations at 24, 44, 68 h. The dosage and frequency of CF was adjusted according to the determined result. RESULTS The EMIT assay was an accurate and easy method to determine the serum concentration of MTX in TDM. The rescue dose of the calcium folinate of standard risk group, middle and high risk group were （47.6 ± 50. 9）, （ 150. 0±114. 2）, （211.8 ± 151.7）rag, respectively. CONCLUSION During the high-does MTX administration, TDM seemed to be beneficial to adjust drug dosage and for taking action in case of over-dose. Therefore, it is helpful to reduce the risk of high dose MTX chemotherapy. KEY WORDS： methotrexate; blood concentration monitoring; high-dose MTX chemotherapy： acute lymphoblastic leukemia

关 键 词：甲氨蝶呤 血药浓度动态监测 大量剂MTX化疗 急性淋巴细胞白血病 

分 类 号：R969[医药卫生—药理学]