大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病消除延迟的影响因素及不良反应  

Influencing factors and adverse reactions of delayed elimination of high-dose methotrexate in the treatment of childhood acute lymphoblastic leukemia

作　　者：孙建明[1] 周光庭 SUN Jianming;ZHOU Guangting(Pharmacy,Kunming Children's Hospital,Yunnan Province,Kunming 650228,China;不详)

机构地区：[1]昆明市儿童医院药剂科,650228 [2]昆明医科大学药学院,昆明市650500

出　　处：《临床合理用药杂志》2022年第7期41-43,46,共4页Chinese Journal of Clinical Rational Drug Use

基　　金：昆明市科技计划项目(No:昆科计字2019-1-S-25318000001431)。

摘　　要：目的分析大剂量甲氨蝶呤(HD-MTX)治疗儿童急性淋巴细胞白血病(ALL)消除延迟的影响因素及不良反应。方法选择2018年1月1日—2020年5月31日于昆明市儿童医院血液科接受HD-MTX治疗的ALL患儿336例,根据是否发生MTX消除延迟分为延迟组124例和未延迟组212例。回顾性分析2组患儿临床相关资料,比较2组患儿性别、年龄、民族、亚叶酸钙解救时间,通过查阅相关文献,分析患儿HD-MTX治疗后出现消除延迟的影响因素,并比较2组不良反应。结果2组性别、年龄、亚叶酸钙解救时间比较差异有统计学意义(P<0.05);延迟组和未延迟组的种族比较差异无统计学意义(P>0.05)。延迟组肝损伤发生率高于未延迟组,差异有统计学意义(P<0.05);延迟组肾损伤、骨髓抑制、黏膜损伤发生率均高于未延迟组,但差异无统计学意义(P>0.05)。结论年龄、亚叶酸钙解救时间对ALL患儿MTX代谢有影响,MTX排泄延迟可增加不良反应。Objective To analyze the influencing factors and adverse reactions of high-dose methotrexate(HD-MTX)in the treatment of childhood acute lymphoblastic leukemia(ALL).Methods 336 children with ALL who were treated with HD-MTX at the Department of Hematology,Kunming Children’s Hospital from January 1,2018 to May 31,2020,were divided into delayed group 124 cases and non-delayed group 212 according to whether the MTX elimination delay occurred.The clinical data of the two groups of children were retrospectively analyzed,and the gender,age,ethnicity and leucovorin rescue time of the two groups of children were compared.By consulting relevant literature,influencing factors of the delay in elimination of the children after HD-MTX treatment were analyzed,compared the adverse reactions of the two groups.Results There were statistically significant differences in gender,age and leucovorin rescue time between the two groups(P<0.05);There was no statistically significant difference in race between the delayed group and the non-delayed group(P>0.05).The incidence of liver injury in the delayed group was higher than that in the non-delayed group,the difference was statistically significant(P<0.05).The incidence of renal injury,bone marrow suppression and mucosal damage in the delayed group were higher than those in the non-delayed group,but the difference was not statistically significant(P>0.05).Conclusion Age and leucovorin rescue time have an impact on MTX metabolism in children with ALL,and delayed MTX excretion can increase adverse reactions.

关 键 词：急性淋巴细胞白血病 儿童 甲氨蝶呤 血药浓度 消除延迟 不良反应 

分 类 号：R733.71[医药卫生—肿瘤]