大剂量MTX不同给药方式治疗淋巴瘤的血药浓度与毒副反应研究  

A study on serum concentrations and toxicities of two regimens of high-dose MTX in patients with NHL

作　　者：杨琳[1] 谢瑞祥[1] 杨瑜[2] 陈道光[2] 邹思平[2] 

机构地区：[1]福建医科大学教学医院福建省肿瘤医院药剂科,福建福州350014 [2]福建医科大学教学医院福建省肿瘤医院内科,福建福州350014

出　　处：《安徽医药》2015年第11期2183-2186,共4页Anhui Medical and Pharmaceutical Journal

基　　金：国家临床重点专科建设项目;福建省卫生厅青年课题(No2013-1-8)

摘　　要：目的比较大剂量甲氨蝶呤(HD-MTX)治疗非霍奇金淋巴瘤(NHL)不同给药方式(6 h和24 h持续静脉滴注)MTX血药浓度和毒副反应的区别,并探讨MTX滴注结束后24 h、48 h发生延迟排泄与临床毒副反应的相关性。方法筛选得到该院HD-MTX单药化疗NHL患者44例,共124例次。分别记录6 h给药组和24 h给药组MTX滴注结束后0、12、18、24、48 h的血药浓度和毒副反应,用SPSS进行数据统计分析。结果 6 h给药组0、12 h平均血药浓度分别为(304.88±137.67)、(4.93±4.39)μmol·L^(-1),明显高于24 h给药组(80.14±51.93)、(3.88±2.27)μmol·L^(-1)(P均<0.05)。6 h给药组发生白细胞、中性粒细胞下降,谷丙转氨酶、谷草转氨酶升高例次数均少于24 h组(P<0.05)。滴注结束后48h延迟排泄与非延迟排泄比较,6 h给药组发生血红蛋白下降例次数增加(P<0.05);24 h给药组发生白细胞、中性粒细胞下降,谷丙转氨酶、谷草转氨酶升高例次数增加(P<0.05)。结论 6 h给药方式预防和治疗淋巴瘤中枢转移更有优势;延迟排泄会加重毒副反应,可从相关代谢酶单核苷酸基因多态性方面进一步探讨。Objective TTo compare the HD-MTX serum concentrations and adverse reactions of two regimens（ 6-hour and 24-hour continuous venous infusion） in NHL patients and explore the connecting between 24,48 h excretion delays and adverse reactions.Methods 44 NHL patients with MTX monotherapy（ total 124 courses） were screened out. Record the serum concentrations of 0,12,18,24,48 h and the adverse reactions,Data were analyzed by SPSS. Results The average MTX serum concentrations of 0h and 12 h in6-hour group were significantly higher than 24-hour group（ 304. 88 ± 137. 67） vs（ 80. 14 ± 51. 93） μmol·L^-1,（ 4. 93 ± 4. 39） vs（ 3. 88± 2. 27） μmol·L^-1,both two P〈0. 05）. The toxicities of WBC,NE,ALT,AST in 6-hour group were lower than 24-hour group（ P〈0. 05）. The toxicity of HB in 6-hour group and the toxicities of WBC,NE,ALT,AST in 24-hour group were higher when excretion delay occurred at 48 h after administration（ P〈0. 05）. Conclusion 6-hour infusion is more preferable to prevent and treat CNS replase.There are more toxicities when excretion delay occurred,it is worthy to further explore SNPs.

关 键 词：甲氨蝶呤 非霍奇金淋巴瘤 给药方式 血药浓度 毒副反应 

分 类 号：R733.1[医药卫生—肿瘤]