大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的不良反应分析  

Analysis of adverse reactions of high-dose methotrexate in children with acute lymphoblastic leukemia

作　　者：张敬铁 ZHANG Jingtie(Department of Pharmacy,Yishui County People's Hospital,Shandong Province,Linyi 276400,China)

机构地区：[1]山东省沂水县人民医院药剂科,276400

出　　处：《临床合理用药杂志》2020年第11期19-20,共2页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的不良反应发生情况。方法选择2018年7月-2019年7月沂水县人民医院收治的儿童急性淋巴细胞白血病患儿120例,按照分子生物学(MICM)分型法,结合相关危险因素,将所有患儿分为低度危险组(LR组)33例、中度危险组(IR组)49例、高度危险组(HR组)38例。患儿均接受大剂量甲氨蝶呤治疗,观察治疗过程中出现的不良反应,比较LR组、IR组和HR组患儿不良反应发生情况。结果以不低于Ⅱ级作为不良反应判断标准,120例患儿中,中性粒细胞计数减少、丙氨酸氨基转肽酶升高、血红蛋白降低、血小板减少、血肌酐升高、心肌酶升高、黏膜损伤、呕吐、腹泻发生率分别为67.5%、31.7%、50.0%、9.2%、5.0%、7.5%、41.7%、20.8%、8.3%。3组危险度分级不同患儿呕吐与黏膜损伤发生率比较差异有统计学意义(P<0.01);3组患儿中性粒细胞计数减少、丙氨酸氨基转肽酶升高、血红蛋白降低、血小板减少、血肌酐升高、心肌酶升高、腹泻发生率比较差异无统计学意义(P>0.05)。结论临床治疗儿童急性淋巴细胞白血病需规范使用大剂量甲氨蝶呤,提前采取针对性措施,能够降低不良反应发生率。Objective To analyze the adverse reactions of high-dose methotrexate in children with acute lymphoblastic leukemia.Methods 120 children with acute lymphoblastic leukemia treated in Yishui County People’s Hospital from July2018 to July 2019 were selected.According to the molecular biology(MICM)classification method and combining relevant risk factors,all children were divided into low-risk group(LR group)33 cases,intermediate-risk group(IR group)49 cases,and high-risk group(HR group)38 cases.All children received high-dose methotrexate treatment,and observed adverse reactions during the treatment,and the adverse reactions of children in LR group,IR group and HR group were compared.Results Take the level of not lower thanⅡas the judgment standard of adverse reactions,among 120 children,the incidence of decreased neutrophil count,increased alanine aminotransferase,decreased hemoglobin,thrombocytopenia,increased serum creatinine,increased myocardial enzymes,mucosal damage,vomiting,and diarrhea were 67.5%,31.7%,50.0%,9.2%,5.0%,7.5%,41.7%,20.8%,8.3%.There was a statistically significant difference in the incidence of vomiting and mucosal injury among the three groups of children(P<0.01);There was no significant difference in the incidence of neutrophil count,increased alanine aminotransferase,decreased hemoglobin,thrombocytopenia,increased serum creatinine,elevated myocardial enzymes,and diarrhea in the three groups(P>0.05).Conclusion In the clinical treatment of childhood acute lymphoblastic leukemia,it is necessary to standardize the use of high-dose methotrexate,and take targeted measures in advance to reduce the incidence of adverse reactions.

关 键 词：甲氨蝶呤 大剂量 儿童急性淋巴细胞白血病 不良反应 

分 类 号：R733.71[医药卫生—肿瘤]