口服低剂量甲氨蝶呤致化疗性口腔黏膜炎1例及文献回顾  

Chemotherapy-induced oral mucositis induced by low dose methotrexate:a case report and literature review

作　　者：王珊珊 马喜兴[2] 李艳玲[2] 刘永红[1] WANG Shanshan;MA Xixing;LI Yanling;LIU Yonghong(Department of Oral Medicine,The Second Hospital of Hebei Medicine University,Shijiazhuang 050000,China;Dermatological Department,The Second Hospital of He-bei Medicine University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院口腔内科,河北石家庄050000 [2]河北医科大学第二医院皮肤科,河北石家庄050000

出　　处：《口腔疾病防治》2023年第9期660-666,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：河北省科技厅卫生健康创新专项项目(21377713D)。

摘　　要：目的探讨低剂量甲氨蝶呤导致化疗性口腔黏膜炎的诊治,为临床提供参考。方法报道银屑病患者短期应用低剂量甲氨蝶呤(1周内最高累积用药量为15 mg)导致重度化疗性口腔黏膜炎1例,并结合文献进行回顾性分析。结果该病例因低剂量应用甲氨蝶呤(第1、2、4周,隔天1次,每次口服2.5 mg;第3周,连续3天,每次2.5 mg,共2次,1周内最高累积用药量为15 mg)治疗银屑病,约在第3周不规律用药后,患者逐渐出现重度口唇糜烂、疼痛、进食困难以及双腿皮肤糜烂;入院后停用甲氨蝶呤,给予康复新液等局部对症治疗,合并中性粒细胞减少时全身应用重组人粒细胞集落刺激因子。治疗后,患者化疗性口腔黏膜炎和皮肤损害得到改善。文献回顾表明,化疗性口腔黏膜炎是高剂量应用甲氨蝶呤后的毒性反应,而低剂量应用甲氨蝶呤导致重度化疗性口腔黏膜炎的病例较为少见。研究发现,患者合并的危险因素越多,如口腔局部状况差以及患者合并肝肾功能障碍、糖尿病等全身系统性疾病时,发生化疗性口腔黏膜炎的危险程度越高。临床医师在应用化疗药物前要尽可能联合口腔医师处理相关口腔疾病;患者服用甲氨蝶呤时,应注意患者的全身状况及易感因素,规范给药频次和剂量,采取个性化治疗方案,同时给予患者详细的用药指导,防止用药错误导致不良后果的发生。若出现甲氨蝶呤中毒,应及时停药、解毒,给予积极对症支持治疗。口腔基础护理、冷冻疗法、激光疗法、营养支持、止痛药物等是化疗性口腔黏膜炎常用的治疗方法;当伴有中性粒细胞减少时可以考虑全身应用粒细胞集落刺激因子。结论临床上需警惕低剂量甲氨蝶呤导致重度化疗性口腔黏膜炎的发生。Objective To investigate the diagnosis and treatment for oral mucositis induced by low-dose methotrexate and to provide a reference for clinicians.Methods A case of severe chemotherapy-induced oral mucositis caused by short-term use of low-dose methotrexate(the maximum cumulative dose within 1 week)was reported and reviewed in combination with the literature.Results The patient was treated with low-dose methotrexate(2.5 mg orally every other day at weeks 1,2,and 4;the third week,2.5 mg each time for 3 consecutive days for twice,with a maximum cumulativedose of 15 mg within a week).After irregular medication for approximately three weeks,the patient gradually developed severe erosion of the lips,pain,difficulty eating,and skin erosion on both legs.Methotrexate was stopped after admission,and local symptomatic treatments such as Kangfuxin solution were given.Recombinant human granulocyte colony-stimulating factor was used systemically when combined with neutropenia.After treatment,the chemotherapy-induced oral mucositis and skin lesions were improved.A literature review shows that chemotherapy-induced oral mucositis is a toxic reaction to high-dose methotrexate,while cases of severe chemotherapy-induced oral mucositis caused by low-dose methotrexate are rare.Studies have found that the more risk factors patients have,such as poor local oral conditions and systemic diseases such as liver and kidney dysfunction and diabetes,the higher the risk of chemotherapy-induced oral mucositis.Clinicians should cooperate with dentists to address oral diseases as much as possible before using chemotherapy drugs.In addition,when ordering patients to take methotrexate,we should pay attention to the patient's general condition and susceptibility factors,standardize the frequency and dose of administration,adopt personalized treatment plans,and give patients detailed medication education to prevent the occurrence of adverse consequences caused by medication errors.If methotrexate poisoning occurs,the drug should be stopped in time,de

关 键 词：甲氨蝶呤 化疗性口腔黏膜炎 寻常型银屑病 骨髓抑制 慢性牙周炎 粒细胞集落刺激因子 危险因素 

分 类 号：R78[医药卫生—口腔医学]