小剂量甲氨蝶呤致药品不良反应文献分析  

Literature analysis of adverse drug reactions caused by low-dose methotrexate

作　　者：赵娅[1,2] 凌霄 杨亚蕾 张博[1,2] 康冰亚 陈小菲[1,2] 张辉 李春晓[1,2,3] ZHAO Ya;LING Xiao;YANG Ya-lei;ZHANG Bo;KANG Bing-ya;CHEN Xiao-fei;ZHANG Hui;LI Chun-xiao(Department of Pharmacy,First Affiliated Hospital,Henan University of Chinese Medicine,Henan Zhengzhou 450000,China;Henan Provincial Engineering Laboratory for Clinical Evaluation Technology of TCM,Henan Zhengzhou 450000,China;Henan Provincial Co-construction Collaborative Innovation Center for Chinese Medi-cine and Respiratory Diseases,Education Ministry of P.R.China,Henan University of Traditional Chinese Medicine,Henan Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院药学部,河南郑州450000 [2]中药临床评价技术河南省工程实验室,河南郑州450000 [3]河南中医药大学,呼吸疾病中医药防治省部共建协同创新中心,河南郑州450000

出　　处：《中国医院药学杂志》2021年第5期521-526,共6页Chinese Journal of Hospital Pharmacy

基　　金：河南省中医管理局河南省中医药科学研究专项课题(编号:2016ZY1006);河南省中医药科学研究专项课题(编号:2019JDZX2046)。

摘　　要：目的:分析小剂量甲氨蝶呤导致药品不良反应发生的特点和规律,探讨影响药品不良反应的相关因素,为临床用药提供参考。方法:检索自1995-2020年CNKI中国期刊全文数据库、维普中文科技期刊文献数据库、万方数字化期刊全文数据库、PubMed、Cochrane Library、Embase、Web of Science数据库关于小剂量甲氨蝶呤不良反应的个案报告并进行汇总分析。结果:小剂量甲氨蝶呤导致不良反应的个案报道共计93例;发生不良反应的平均年龄为(55.3±18.1)岁,60岁以上的占比48.39%,男女比例为1∶2.25;给药次数小于等于3次即发生药品不良反应的有33例(35.48%),不良反应发生在30 d内的占比52.5%;不良反应涉及的系统多达15种以上,其中以胃肠系统损害(27.5%),血液系统损害(26.5%);皮肤及其附件损害(12.4%)为主。结论:临床中使用小剂量的甲氨蝶呤亦需加强监测,密切防范严重药品不良反应的发生,尤其应关注高龄、肾功能不全、合并用药种类较多的患者,有条件的患者在使用药物前应进行MTHFR基因检测。OBJECTIVE To explore the characteristics and regularity of adverse drug reactions(ADR)induced by low-dose methotrexate and provide reference for rational drug in clinic.METHODS The domestic and foreign literatures of CNKI,VIP,Wanfang, PubMed, Cochrane Library, EMBASE and Web of Science from 1995 to 2020 were searched for case reports of ADR of low-dose methotrexate.RESULTS There were 93 cases of ADR caused by low-dose methotrexate.The average age of ADR was(55.3±18.1)years, 48.39% of them were over 60 years old and the ratio of male-to-female was 1∶2.25;33 cases(35.48%)had ADR when the frequency of administration was less than or equal to 3 times.And 52.5% of ADR occurred within 30 days, involving gastrointestinal system disorders(27.5%),hematological disorders(26.5%)and skin and its appendage disorders(12.4%).CONCLUSION It is necessary to strengthen the monitoring of low-dose methotrexate to prevent or reduce the occurrence of serious ADR,especially in elders, renal insufficiency, patients with more types of drugs.Determination of polymorphisms of MTHFR should be performed in patients before drug dosing.

关 键 词：小剂量甲氨蝶呤 药品不良反应 文献分析 

分 类 号：R979.12[医药卫生—药品]