小儿急性淋巴细胞白血病亚甲基四氢叶酸还原酶基因多态性及甲氨蝶呤血药浓度监测的意义  

The significance of detecting MTHFR gene polymorphism and the plasmaconcentration of MTX in ALL infantle patients

作　　者：陈丽萍[1] 吴云波[1] 刘静 CHEN Li-ping;WU Yun-bo;LIU Jing(Dept.of Pharmacy&Instrument,Yantai Sanatorium of Jinan Military Region(former),Yantai,Shandong 264003,China)

机构地区：[1]济南军区烟台疗养院药械科,山东烟台264003 [2]陆军总医院药理科,北京100700

出　　处：《实用医药杂志》2018年第10期894-896,共3页Practical Journal of Medicine & Pharmacy

摘　　要：目的探讨在小儿急性淋巴细胞白血病(ALL)使用大剂量甲氨蝶呤(HDMTX)化疗期间,MTX动态血药浓度与亚甲基四氢叶酸还原酶(MTHFR)基因多态性的相关性。方法取小儿外周血2 ml,提取基因DNA,检测MTHFR基因型,根据基因型调整个体化用药方案,应用荧光偏振免疫分析法(FPIA)监测小儿MTX 48 h、72 h动态血药浓度。结果基因型检测显示患者发生不良反应率明显下降(39.00%vs 26.80%,P<0.05);适当降低MTX量或增加解救药物量,可减少患者不良反应发生率。结论 ALL小儿HDMTX化疗期间可根据监测MTHFR基因型进行个体化治疗,有效减少小儿严重不良反应的发生。Objective To investigate the relativity of dynamic plasmaconcentration of methotrexate(MTX)and methylene tetrahydrofolate reductase(MTHFR)gene polymorphism during acute lymphoblastic leukemia(ALL)children received high dose of methotrexate(HDMTX)chemotherapy.Methods Taking 2ml peripheral blood,extracting DNA for detecting MTHFR genotypes;adjusting medication regimens individually according to genotype,using fluorescence polarization immunoassay(FPIA)to monitor the dynamic plasma concentration of MTX in 44h and 72h were taken.Results Detecting genetypes shown child-patient's unward reaction had decreased(39.00%vs 26.80%,P<0.05);And,decreasing the dosage of MTX or increasing detoxicant can reduce unward reaction incidence.Conclusion Individualized medication could be achieved according to MTHFR genotype during ALL children received HDMTXchemotherapyto reduce severe unward reaction.

关 键 词：急性淋巴细胞白血病 甲氨蝶呤 亚甲基四氢叶酸还原酶 基因多态性 

分 类 号：R557.4[医药卫生—血液循环系统疾病]