右美沙芬治疗甲氨蝶呤诱发急性脑病1例报告  

Dextromethorphan in the treatment of acute encephalopathy induced by methotrexate:a case report

作　　者：罗文弢 陈霁晖[1] 张鑫 喻娟娟 LUO Wentao;CHEN Jihui;ZHANG Xin;YU Juanjuan(Department of Pharmacy,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Pharmacy,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,Guangdong China;Department of Pediatric Hematology/Oncology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院临床药学部,上海20092 [2]南方医科大学珠江医院药学部,广东广州510280 [3]上海交通大学医学院附属新华医院儿童血液肿瘤科,上海20092

出　　处：《临床儿科杂志》2025年第2期141-146,共6页Journal of Clinical Pediatrics

摘　　要：目的 提高临床对甲氨蝶呤诱发的急性脑病的认识,探讨右美沙芬特异性治疗甲氨蝶呤相关中枢神经毒性的有效性和安全性。方法 回顾性分析1例大剂量甲氨蝶呤静脉注射联合甲氨蝶呤鞘注引起急性脑病的诊治经过,并对已发表文献进行复习,评估右美沙芬的潜在疗效和安全性。结果 该患儿诊断伯基特淋巴瘤IV期,纳入CNCL-B-NHL-2017 C组方案化疗,首次给予甲氨蝶呤后当天出现头痛、视物不能等临床症状,头颅MRI显示双侧枕叶皮层区及双侧小脑半球见多发斑片状T2WI高信号影,给予右美沙芬治疗后,患儿双眼视力逐渐恢复,临床症状缓解。结论 对甲氨蝶呤诱发的急性脑病,早期给予右美沙芬治疗,可能对甲氨蝶呤引起的严重神经毒性有治疗作用。Objective To improve the understanding of methotrexate-induced acute encephalopathy and explore the efficacy and safety of dextromethorphan in the treatment of methotrexate-induced central neurotoxicity.Methods A retrospective analysis was performed on a patient in our hospital with acute encephalopathy caused by high-dose intravenous methotrexate combined with intrathecal methotrexate.Additionally,the published literature was reviewed to evaluate the potential efficacy and safety of dextromethorphan.Results The child was diagnosed with stage IV Burkitt lymphoma and was treated with chemotherapy in the China Net Childhood Lymphoma-mature B-cell lymphoma 2017(CNCL-B-NHL-2017)C group.On the day following the initial administration of methotrexate,the patient exhibited clinical symptoms,including headache and visual impairment,and multiple patchy T2WI hypersignal images in the bilateral occipital cortex and bilateral cerebellar hemispheres were observed on head MRI.After oral administration of dextromethorphan,there was a gradual recovery of binocular vision and a reduction in the clinical symptoms.Conclusion In the case of acute encephalopathy induced by methotrexate,early treatment with dextromethorphan may have a therapeutic effect on severe neurotoxicity induced by methotrexate.

关 键 词：甲氨蝶呤 神经毒性 右美沙芬 

分 类 号：R742[医药卫生—神经病学与精神病学]