甲氨蝶呤目标血药浓度在儿童急性淋巴细胞白血病中的应用  

Application of target plasma concentrations of methotrexate in children with acute lymphoblastic

作　　者：张玉玲 刘承梅 曾小青[3] 陈小芸[3] 刘礼平[3] 严志民[3] 钟雯婷[3] 林传明[3] 李海亮[3] ZHANG Yuling;LIU Chengmei;ZENG Xiaoqing;CHEN Xiaoyun;LIU Liping;YAN Zhimin;ZHONG Wenting;LIN Chuanming;LI Hailiang(The First Clinic Institute,Gannan Medical University,Ganzhou 341000,China)

机构地区：[1]赣南医学院第一临床医学院,江西赣州341000 [2]赣州市妇幼保健院儿内科,江西赣州341000 [3]赣南医学院第一附属医院血液科,江西赣州341000

出　　处：《实用医学杂志》2018年第18期3093-3096,共4页The Journal of Practical Medicine

基　　金：江西省卫生厅科技计划(编号:20154052)

摘　　要：目的根据甲氨蝶呤(MTX)的血药浓度调整MTX的剂量,探讨MTX目标血药浓度(T系ALL48μmol/L,B系ALL 34μmol/L)在儿童急性淋巴细胞白血病(ALL)中的应用价值。方法选择2013年3月-2017年1月在赣南医学院第一附属医院血液科诱导治疗完全缓解的ALL患儿56例,分为2组,对照组34例,经验性使用MTX;实验组22例,根据MTX血药浓度调整MTX剂量。统计分析ALL患儿MTX的血药浓度、不良反应及复发率、死亡率。结果 3、4、5 g/m^2MTX治疗的ALL患儿24 h MTX血药浓度分别是(44.80±31.35)μmol/L、(57.09±42.07)μmol/L、(74.25±63.73)μmol/L,5 g/m^2与3、4 g/m2血药浓度比较差异有统计学意义(P <0.05)。实验组第2、3疗程MTX血药浓度达目标血药浓度百分率高于对照组(P <0.05)。实验组肝功能损害发生率高于对照组(P <0.05)。两组ALL儿童复发率、死亡率比较差异无统计学意义。结论 MTX血药浓度监测能保障疗效和安全,是个体化治疗的有效手段,应在临床推广使用。根据MTX血药浓度调整MTX剂量,提高MTX血药浓度达目标血药浓度百分率,安全性好,复发率、死亡率不高于经验性使用MTX。Objective To investigate application value of targeting plasma concentration of MTX in children with lymphoblastic leukemia.Methods A total of 56 children with acute lymphoblastic leukemia after complete remission from inductive therapy from March 2013 to January 2017 were divided into two groups:control group(n=34)and experimental group(n=22):The former was managed with MTX by experience and the latter with MTX based on targeting MTX plasma concentrations.MTX plasma concentrations,side effects,recurrence rate and mortality were comparatively analyzed between the two groups.Results The plasma concentrations of 3,4 and 5 g/m2 of MTX dose in the children were(44.80±31.35)μmol/L,(57.09±42.07)μmol/L and(74.25±63.73)μmol/L,respectively.The plasma concentration of 5 g/m2 of MTX dose was higher than those of 3 g/m2 and 4 g/m2 of MTX dose(P<0.05).There was significant difference in the plasma concentration between the control group and experimental group at the second and third course(P<0.05).The incidence rate of liver dyfunction of the experimental group was higher than that of the control group(P<0.05).No difference was observed in recurrence rate between the two groups,and so it was with the mortality.Conclusion The monitoring of methotrexate blood concentration can guarantee the efficacy and safety.It is an effective method for individualized treatment and should be used in clinic.Adjusting methotrexate(MTX)dose based on target MTX plasma concentration can increase the rate of MTX plasma concentration achieving target plasma concentration.It is advantageous,for it is safe without increasing the rates of recurrence and mortality.

关 键 词：甲氨蝶呤 血药浓度 急性淋巴细胞白血病 不良反应 

分 类 号：R733.71[医药卫生—肿瘤]