类风湿关节炎患者甲氨蝶呤中毒6例临床分析  

Clinical analysis of methotrexate intoxication in 6 rheumatoid arthritis cases

作　　者：赵遐[1] 苏建明[1] 

机构地区：[1]江苏省中医院,210029

出　　处：《中国实用医药》2015年第2期14-16,共3页China Practical Medicine

摘　　要：目的 探讨类风湿关节炎患者甲氨蝶呤中毒的临床特点、治疗及预后。方法 回顾分析6例小剂量甲氨蝶呤引起中毒的类风湿关节炎患者的临床资料及诊治过程：其中5例为误服,1例是小剂量甲氨蝶呤引起的急性骨髓抑制。结果 5例患者出现口腔黏膜溃烂,2例出现口腔出血,1例便血,2例腹泻,1例皮肤破溃、瘀斑,1例全身散在皮疹伴瘙痒;血常规：白细胞（WBC）（0.77~5.11）×10^9/L,中性粒细胞（0.13~3.01）×10^9/L,血小板（PLT）（1~70）×10^9/L;2例肝功能损伤。治疗给予亚叶酸钙解救,应用造血因子、成分输血、早期经验性应用抗生素、保肝治疗、加强基础护理等综合救治措施。6例患者均康复出院。结论 急性粒细胞缺乏、血小板减少、肝功能损伤是甲氨蝶呤严重的不良反应,处理及时、得当可取得良好疗效。Objective To explore the clinical characteristics, treatment and prognosis of methotrexate intoxication in rheumatoid arthritis patients. Methods The clinical, data and treatment procedures of methotrexate intoxication in 6 rheumatoid arthritis patients were retrospectively analyzed. Among them, there were 5 accidental administration cases and 1 acute myelosuppression case by small dose of methotrexate. Results There were 5 cases with oral mucosa fester, 2 cases with oral hemorrhage, 1 case with hemafecia, 2 cases with diarrhea, 1 case with skin ulceration and ecchymosis, and 1 case with systemic rash and pruritus. The resuhs of blood routine examination were as follow, white blood cell WBC was （0.77-5.11）×10^9/L, neutrophile granulocyte was （0.13-3.01）× 10^9/L, and platelets （PLT） was （1-70）×10^9/L. There were 2 cases with liver function injury. The treatment was performed by calcium folinate, with comprehensive rescue measures, such as the application of haemopoietic factor, blood component transfusion, early experiential antibiotics, liver protection, and enhanced basic nursing. All the 6 patients were cured and left hospital. Conclusion Acute neutropenia, thrombocytopenia and liver function injury are severe adverse reactions of meth0trexate. Timely and appropriate treatments can provide good clinical effect.

关 键 词：甲氨蝶呤 急性粒细胞缺乏症 类风湿关节炎 

分 类 号：R593.22[医药卫生—内科学]