儿童急性淋巴细胞白血病甲氨蝶呤排泄延迟的发生及影响因素分析  

Influencing factors of delayed methotrexate excretion in children with acute lymphoblastic leukemia

作　　者：李晓[1] 郭切[1] 王玲珍[2] 李凤晓[1] 梁瑜[1] 全香花[1] LI Xiao;GUO Qie;WANG Ling-zhen;LI Feng-xiao;LIANG Yu;QUAN Xiang-hua(Department of clinical pharmacy,The Affiliated Hospital of Qingdao University,Shandong Qingdao 266003,China;Pediatric Hematology Oncology Department,The Affiliated Hospital of Qingdao University,Shandong Qingdao 266003,China)

机构地区：[1]青岛大学附属医院药学部,山东青岛266003 [2]青岛大学附属医院儿童血液肿瘤科,山东青岛266003

出　　处：《中国医院药学杂志》2022年第20期2144-2147,共4页Chinese Journal of Hospital Pharmacy

基　　金：山东省医学会临床科研专项资金-临床药学应用研究项目(编号:YXH2019ZX010)。

摘　　要：目的:研究儿童急性淋巴细胞白血病(ALL)大剂量甲氨蝶呤(HD-MTX)化疗后排泄延迟的发生及影响因素,为HDMTX个体化给药提供参考依据。方法:收集2016年1月至2020年9月于青岛大学附属医院儿童血液肿瘤科就诊的新发ALL患儿完整的HD-MTX化疗资料。采用SPSS19.0软件对HD-MTX治疗后发生排泄延迟情况及各方面的影响因素进行分析。结果:患儿给药后排泄延迟发生率为13.67%。排泄正常组与排泄延迟组患儿相比,病情危险度(P=0.002)、血红蛋白(Hb)水平(P=0.001)、白蛋白(ALB)水平(P=0.002)及MTX剂量(P<0.01)差异有统计学意义;是否合用PPIs差异无统计学意义。Logistic回归分析结果显示ALB水平是HD-MTX化疗后发生排泄延迟的保护因素(OR=0.916;P=0.007),病情危险度是发生排泄延迟的危险因素(OR=1.849;P=0.012)。结论:ALL患儿的MTX给药剂量,病情危险度和Hb、ALB水平可能与排泄延迟有关;ALB水平是HD-MTX排泄延迟的保护因素,疾病危险程度是排泄延迟的危险因素。因此,用药前应密切关注低蛋白血症儿童及高危患儿。OBJECTIVE To investigate the influencing factors of delayed methotrexate excretion after high-dose methotrexate(HD-MTX)chemotherapy in children with acute lymphoblastic leukemia(ALL),thus providing theoretical evidence for individualized administration in HD-MTX chemotherapy.METHODS The data from children with ALL treated in Pediatric Hematology Oncology Department of the Affiliated Hospital of Qingdao University from January 2016 to September 2020 were collected.SPSS19.0software was used to analyze the influencing factors on excretion delay after HD-MTX treatment.RESULTS The incidence of delayed excretion was 13.67%.There were significant differences in risk stratification(P=0.002),hemoglobin(HB)level(P=0.001),albumin(ALB)level(P=0.002)and MTX dose(P<0.01)between normal excretion group and delayed excretion group.There was no significant difference between normal excretion group and delayed excretion group with the combined application of PPIs.Logistic regression analysis showed that ALB level was a protective factor for delayed excretion after HD-MTX chemotherapy(OR=0.916,P=0.007),and the risk stratification was a risk factor for delayed excretion(OR=1.849,P=0.012).CONCLUSION The dose of MTX,the risk stratification and the levels of Hb and ALB may be related to delayed excretion in children with ALL.ALB level is aprotective factor and the risk stratification is a risk factor for delayed excretion of HD-MTX.Close attention should be paid to children with hypoproteinemia and high-risk children before HD-MTX chemotherapy.

关 键 词：大剂量甲氨蝶呤 排泄延迟 儿童急性淋巴细胞白血病 PPIS 影响因素 

分 类 号：R969.3[医药卫生—药理学]