肾图指导大剂量甲氨喋呤治疗急性淋巴细胞白血病的价值研究  

Clinical Value of Renogram for High Dose MTX in Treatment of Children with ALL

作　　者：卢颖 李凤[2] 

机构地区：[1]遂宁市中心医院核医学科,四川遂宁629000 [2]遂宁市中心医院检验科

出　　处：《解放军预防医学杂志》2017年第7期771-773,共3页Journal of Preventive Medicine of Chinese People's Liberation Army

摘　　要：目的研究肾图指导大剂量甲氨喋呤(MTX)治疗急性淋巴细胞白血病(ALL)的价值。方法选择2010年3月-2015年3月我院血液科收治的ALL患者80例,入院后于我院实行大剂量MTX治疗,分为试验组(40例,实行肾图指导),对照组(40例,未实行肾图指导);试验组依据患者的实际肾脏过滤情况对应给予药物MTX剂量;观察指标比较两组患者治疗期间黏膜炎、胃肠道反应、肝功能损害及骨髓抑制等不良反应的发生情况;统计分析两组患者的MTX使用的浓度和亚叶酸钙(CF)与MTX的比值情况。结果试验组有胃肠道反应5例(12.50%),对照组有11例(27.50%);试验组黏膜炎1~4级5例(12.50%),对照组18例(45.00%);试验组合并感染1例(2.50%),对照组12例(30.00%);两组间胃肠道反应、黏膜炎和合并感染情况差异具有统计学意义(P<0.01);试验组MTX浓度0.1~1.0μmol/L 36例(90.00%),对照组24例(60.00%),差异具有统计学意义(P<0.01);临床上CF/MTX的有效剂量范围为2~3%,试验组占38例(95.00%),对照组占27例(67.50%),差异具有统计学意义(P<0.01)。结论对ALL患者采用肾图指导MTX的使用剂量,不仅可以使MTX的药物浓度平衡,同时可减少患者不良反应的发生,并减少了CF的使用剂量。Objective To investigate the clinical value of renogram for guiding high-dose MTX in the treatment of children with ALL.Methods Eighty cases of ALL treated in our hospital from March 2010 to March 2015 were selected as subjects and given high-dose MTX,who were divided into the observation group（ 40 cases,given renogram） and control group（ 40 cases,not given renogram）.The observation group was given MTX according to the filtration rate of the kidney.The indexes of the two groups,including mucositis,gastrointestinal reactions,liver function lesion and myelosuppression,were observed.The concentration of MTX used in the two groups and rate of CF and MTX were compared.Results Five cases（ 12.50%） had gastrointestinal reactions in the observation group,compared with eleven cases（ 27.50%） in the control group.There were five cases of 1-4 level mucositis（ 12.50%） in the observation group,and eighteen cases（ 45.00%） in the control group.There was one case（ 2.50%）of concurrent infection in the observation group,but twelve cases（ 30.00%） in the control group.The difference of gastrointestinal reactions,mucositis and concurrent infections between the two groups was of statistic significance（ P〈0.01）.There were thirty-six cases（ 90.00%） of 0.1-1.0 μmol/L MTX in the observation group,and twenty-four cases（ 60.00%） in the control group.The difference was statistically significant（ P〈0.01）.Clinically,the effective doses of CF/MTX ranged from 2 to 3%.The observation group accounted for 95.00%（ 38 cases） and control group 67.50%（ 27 csaes）,so the difference was statistically significant（ P〈0.01）.Conclusion Renogram used for guiding high-dose MTX in the treatment of children with ALL can not only balance the drug levels of MTX,but also decrease adverse reactions and CF usage.

关 键 词：肾图 甲氨喋呤 急性淋巴细胞白血病 亚叶酸钙 不良反应 

分 类 号：R733.7[医药卫生—肿瘤]