大剂量甲氨蝶呤致MTHFR突变患者甲氨蝶呤排泄延迟及肝损害1例  

Methylenetetrahydrofolate reductase mutation with delayed methotrexate excretion and liver damage caused by high-dose methotrexate:one case report

作　　者：李晓[1] 全香花[1] 徐文[1] 张小蕾[1] 李静[1] LI Xiao;QUAN Xianghua;XU Wen;ZHANG Xiaolei;LI Jing(Department of Clinical Pharmacy,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

出　　处：《中国医院药学杂志》2024年第14期1719-1722,共4页Chinese Journal of Hospital Pharmacy

摘　　要：该文介绍1例MTX代谢和排泄基因突变的儿童ALL患者在接受HD-MTX化疗后联合应用PPI和青霉素类药物导致肝损害的过程。该案例可为存在MTX代谢和排泄基因突变的患者以及类似联合用药患者提供一定的参考。通过该案例,建议患者在应用HD-MTX化疗前进行MTX用药基因检测,根据基因检测结果提前适当增减HDMTX的用量,密切监测血药浓度,减少或避免联合应用PPI和青霉素类等可能影响MTX排泄的药物,避免发生MTX排泄延迟或毒副反应。This report described the process of liver damage caused by a combined dosing of proton pump inhibitor(PPI)and penicillin in an ALL child with MTX metabolism and excretion gene mutations after receiving high-dose methotrexate(HD-MTX)chemotherapy.It provided some reference for patients with MTX metabolism and excretion gene mutations,as well as similar combination therapy patients.Therefore methylenetetrahydrofolate reductase(MTHFR)C677T,MTHFR A1298C and ABCB1 C3435T genotyping are recommended to perform before HD-MTX chemotherapy.Based upon the results of genotypic analyses,the dosage of HD-MTX should be appropriately adjusted in advance.Blood concentration of MTX should be closely monitored for avoiding a combined dosing of PPI and penicillin potentially affecting MTX excretion to prevent delayed MTX excretion or adverse drug reaction.

关 键 词：大剂量甲氨蝶呤 排泄延迟 肝损害 基因多态性 联合用药 

分 类 号：R969.2[医药卫生—药理学]