大剂量甲氨蝶呤治疗儿童颅内生殖细胞瘤延迟排泄的影响因素  

Influencing Factors of Delayed Excretion of High-dose Methotrexate in Treatment of Children with Intracranial Germinoma

作　　者：赵嘉澍 梅升辉[1,3] 王睿韬 路瑆[4] 刘宇[5] 赵志刚 ZHAO Jiashu;MEI Shenghui;WANG Ruitao;LU Xing;LIU Yu;ZHAO Zhigang(School of Pharmaceutical Sciences,Capital Medical University,Beijing 100069,China;Department of Pharmacy,Beijing Puren Hospital,Beijing 100062,China;Department of Pharmacy,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;the Second Clinical Division,Peking University School and Hospital of Stomatology/National Clinical Research Center for Oral Diseases/National Engineering Research Center of Oral Biomaterials and Digital Medical Devices/Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Medical Department,Beijing NO.6 Hospital,Beijing 100029,China)

机构地区：[1]首都医科大学药学院,北京100069 [2]北京市普仁医院药剂科,北京100062 [3]首都医科大学附属北京天坛医院药学部,北京100070 [4]北京大学口腔医学院口腔医院第二门诊部国家口腔疾病临床医学研究中心口腔生物材料和数字诊疗装备国家工程研究中心口腔数字医学北京市重点实验室,北京100081 [5]北京市第六医院医务科,北京100029

出　　处：《医学综述》2022年第7期1430-1434,共5页Medical Recapitulate

基　　金：北京市医院管理局重点医学专业发展计划(ZYLX201827)。

摘　　要：目的分析大剂量甲氨蝶呤(HD-MTX)治疗儿童颅内生殖细胞瘤延迟排泄的影响因素。方法纳入2016年6月至2018年7月北京市普仁医院收治的216例采用HD-MTX治疗的颅内生殖细胞瘤患儿的临床资料,对影响颅内生殖细胞瘤患儿HD-MTX延迟排泄的因素进行单因素和多因素分析。结果丙氨酸转氨酶(ALT)、天冬氨酸转氨酶、血清白蛋白、碱性磷酸酶、血肌酐异常组的MTX血药浓度超安全值占比均高于上述指标正常组[52.00%(13/25)比3.66%(7/191)、46.87%(15/32)比2.72%(5/184)、25.00%(18/72)比1.39%(2/144)、29.17%(14/48)比3.57%(6/168)、45.95%(17/37)比1.68%(3/179)](均P<0.01)。Logistic回归分析显示,ALT和血肌酐是评价MTX经亚叶酸钙解救后血药浓度超安全值的影响因素(OR=6.434,95%CI 1.567~26.412,P=0.010;OR=13.081,95%CI 2.712~63.103,P<0.001)。结论血肌酐和ALT是接受HD-MTX治疗颅内生殖细胞瘤患儿MTX延迟排泄的独立危险因素,治疗时应密切关注患者肝肾功能,确保用药安全。Objective To analyze the factors affecting delayed excretion of high-dose methotrexate(HD-MTX)in treatment of intracranial germinoma of children.Methods The clinical data of 216 children with intracranial germinoma treated with HD-MTX in Beijing Puren Hospital from Jun.2016 to Jul.2018 were included,and univariate and multivariate analysis on the factors affecting delayed excretion of HD-MTX in children with intracranial germinoma was performed.Results The ultra-safe values of alanine aminotransferase(ALT),aspartate aminotransferase,serum albumin,alkaline phosphatase and serum creatinine in the abnormal group were higher than those in the normal group[52.00%(13/25)vs 3.66%(7/191),46.87%(15/32)vs 2.72%(5/184),25.00%(18/72)vs 1.39%(2/144),29.17%(14/48)vs 3.57%(6/168),45.95%(17/37)vs 1.68%(3/179)](all P<0.01).Logistic regression analysis showed that ALT and serum creatinine were influential factors for evaluating the ultra-safe value of MTX after calcuim folinate rescue(OR=6.434,95%CI 1.567-26.412,P=0.010;OR=13.081,95%CI 2.712-63.103,P<0.001).Conclusion Serum creatinine and ALT are independent risk factors for delayed MTX excretion in children with intracranial germinoma treated with HD-MTX.Liver and kidney functions of the patients should be paid close attention during treatment to ensure drug safety.

关 键 词：颅内生殖细胞瘤 甲氨蝶呤 血药浓度 

分 类 号：R739.41[医药卫生—肿瘤]