大剂量甲氨蝶呤化疗致儿童骨肉瘤患者肝功能损伤的危险因素分析  

Risk factors associated with hepatic function damage induced by high-dose methotrexate chemotherapy in children with osteosarcoma

作　　者：饶晶晶[1] 张威[1] 朱思源 张清[2] 牛晓辉[2] 赵海涛[2] 甄健存[1] RAO Jing-ing;HANG Wei;ZHU Si-yuan;ZHANG Qing;Niu Xiao-hui;Zhao Hai-tao;ZHEN Jian-cun(Department of Pharnaey,Bejing Jishuitan Hospital,Bejing 100035,China;Department of Orthopedie Oncologyr,Bejing Jishuitan Hospital,Bejing 100035,China)

机构地区：[1]北京积水潭医院药学部,北京100035 [2]北京积水潭医院骨肿瘤科,北京100035

出　　处：《临床药物治疗杂志》2019年第12期40-43,共4页Clinical Medication Journal

基　　金：北京市科技计划课题(Z131107002213029)。

摘　　要：目的:探讨儿童骨肉瘤患者接受大剂量甲氨蝶呤(HD-MTX)化疗后发生肝功能损伤的特点及危险因素,为临床用药提供参考。方法:回顾性分析北京积水潭医院175例骨肉瘤患儿的临床资料,分析患儿的性别、年龄、累计化疗次数、保肝药种类、HD-MTX结束后0、24、48和72 h血药浓度(C0、C24、C48和C72)对化疗后肝功能损伤的影响。结果:在175例患儿共455例次HD-MTX化疗中,共398例次在化疗后发生肝功能损伤,发生率87.47%。单因素分析结果显示年龄、累计化疗次数、C24、C48和C72等因素与化疗后发生肝功能损伤相关。多因素logistic回归分析显示年龄和C24与化疗后肝功能损伤相关,回归系数分别为-0.172及0.180。结论:HD-MTX引起骨肉瘤患儿肝功能损伤发生率高,临床应加强血药浓度监测及时调整解救方案及后续治疗,减少严重肝功能损伤的发生。Objective:To investigate the characteristics and risk factors of hepatic function damage induced by high-dose methotrexate chemotherapy in children with osteosarcoma,and provide a reference for its clinical application.Methods:Clinical datas of 175 children with osteosarcoma were analyzed retrospectively.The effects of gender,age,cumulative number of chemotherapy,type of liver-protecting drugs and the serum concentrations of 0,24,48,72 h(C0,C24,C48,C72) after HD-MTX chemotherapy were analyzed.Results:In the total 455 courses HD-MTX chemotherapy of 175 children,398 courses occurred hepatic function damage,the incidence was 87.47%.Univariate analysis showed that age,cumulative number of chemotherapy,C24,C48,C72 were correlated with hepatic function damage after chemotherapy.Multivariate logistic regression analysis revealed that the age(P <0.001),C24(P <0.05) were associated with the rate of hepatic function damage,and the regression coefficients were-0.172 and 0.180 respectively.Conclusion:The incidence of hepatic function damage in children with osteosarcoma caused by HD-MTX is high,Clinical physicians should monitor the serum concentrations of MTX and timely adjust the rescue and treatment plant,reduce the incidence of severe hepatic function damage.

关 键 词：骨肉瘤 儿童 大剂量甲氨蝶呤 肝功能损伤 

分 类 号：R979.12[医药卫生—药品]