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目的探讨双歧杆菌制剂对大剂量甲氨蝶呤(HD-MTX)治疗ALL患儿所致胃肠道不良反应的影响。方法参照儿童ALL诊疗建议,将152例ALL患儿随机分为2组。治疗组76例。男46例,女30例;年龄2～13岁(中位年龄8岁)。对照组76例。男41例,女35例;年龄2～15岁(中位年龄8.2岁)。2组均为HD-MTX强化及预防性治疗中枢神经系统白血病。治疗组在入院时即予双歧杆菌制剂常规口服(金双歧片:2～6岁,每次1片,每日3次;7～15岁,每次2片,每日3次),3d后开始化疗,双歧杆菌制剂与化疗药物间隔2～3h服用,若WBC<2.0×109L-1即停用。对照组口服复合维生素B片(2～6岁,每次1片,每日3次;7～15岁,每次2片,每日3次)。治疗期间2组均予相应的对症支持治疗(即水化、碱化及四氢叶酸钙解救)。结果双歧杆菌制剂对HD-MTX化疗引起的消化道不良反应有显著改善作用,治疗组恶心、腹痛、腹泻等消化道症状均较对照组显著减轻,肝功能损害亦较对照组减轻。但对于ALL患儿化疗过程中合并的发热和口腔黏膜损害等症状无明显减轻作用。结论双歧杆菌制剂可显著改善白血病患儿HD-MTX化疗引起的胃肠道不良反应。
Objective To investigate the effects of Bifidobacterium on gastrointestinal adverse reactions induced by high dose methotrexate (HD-MTX) in children with ALL. Methods Reference pediatric ALL diagnosis and treatment recommendations, 152 cases of ALL children were randomly divided into two groups. Treatment group of 76 cases. 46 males and 30 females; aged 2 to 13 years (median age 8 years). Control group of 76 cases. 41 males and 35 females; aged 2 to 15 years (median 8.2 years). Both groups were HD-MTX intensive and prophylactic treatment of central nervous system leukemia. The patients in the treatment group were given oral routine bifidobacterium preparations (Jin Bifu tablets: 2 to 6 years old, 1 tablet each time, 3 times daily; 7 ~ 15 years old, 2 tablets each time, 3 times daily) Start chemotherapy, Bifidobacterium preparations and chemotherapy drugs taken 2 ~ 3h intervals, if WBC <2.0 × 109L-1 is disabled. The control group oral compound vitamin B tablets (2 to 6 years old, each time a tablet 3 times a day; 7 to 15 years old, 2 tablets each time, 3 times a day). During treatment, the corresponding symptomatic supportive treatment was given in both groups (ie, hydration, alkalization and rescue of calcium folinate). Results The bifidobacteria preparation significantly improved the gastrointestinal adverse reactions caused by HD-MTX chemotherapy. The nausea, abdominal pain, diarrhea and other gastrointestinal symptoms of the treatment group were significantly reduced compared with the control group, and the liver damage was also alleviated. But for children with ALL during chemotherapy combined fever and oral mucosal damage and other symptoms did not significantly reduce the role. Conclusion Bifidobacterium preparation can significantly improve gastrointestinal adverse reactions caused by HD-MTX chemotherapy in children with leukemia.