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目的监测大剂量甲氨蝶呤(HD-MTX)在治疗儿童急性淋巴细胞白血病(ALL)过程中的血药浓度,分析HD-MTX排泄延迟以及不良反应发生的规律,为临床个体化给药提供依据。方法采用回顾性分析的方法,收集ALL患儿47例,使用HD-MTX化疗108例次,采用FPIA法动态监测患儿MTX的血药浓度,并观察排泄延迟和不良反应发生的规律。结果 HD-MTX排泄延迟68例,24hMTX浓度>10.0μmol/L5例,48hMTX浓度>1.0μmol/L30例,72hMTX浓度>0.1μmol/L33例,HD-MTX的不良反应包括皮肤黏膜损害、胃肠道反应、肝肾功能损害以及发热和骨髓抑制。结论 MTX的消除过程存在个体差异性,HD-MTX化疗过程需要在血药浓度监测下实施,才能最大程度降低不良反应的发生,提高治疗效果。
Objective To monitor the plasma concentration of high-dose methotrexate (HD-MTX) in the treatment of children with acute lymphoblastic leukemia (ALL) and to analyze the delay of HD-MTX excretion and the occurrence of adverse reactions, so as to provide clinical individualized administration in accordance with. Methods A retrospective analysis was performed in 47 children with ALL. HD-MTX chemotherapy was used in 108 cases. The blood levels of MTX in children with FPIA were dynamically monitored. The delay of excretion and the occurrence of adverse reactions were observed. Results The excretion delay of HD-MTX was 68 cases, 24hMTX concentration> 10.0μmol / L in 5 cases, 48hMTX concentration> 1.0μmol / L in 30 cases and 72hMTX concentration> 0.1μmol / L in 33 cases. The adverse reactions of HD- Reaction, liver and kidney dysfunction and fever and myelosuppression. Conclusion There are individual differences in the elimination process of MTX. The HD-MTX chemotherapy needs to be implemented under the monitoring of blood concentration in order to minimize the occurrence of adverse reactions and improve the therapeutic effect.