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MTX是最常用的抗肿瘤药物及抗自身免疫性疾病的二线药物。MTX的不良反应很多，其中全血减少症是较严重的毒性反应之一。临床表现主要是血象三系下降，骨愎抑制。常可因感染和颅内出血等并发症而致患者死亡。我们发现无论是大、中、小剂量MTX的治疗都可产生全血减少症。MTX的排泄主要通过肾脏，肾脏代谢的快慢与毒性反应的发生及严重程度有很大关联。对ATFX严重的毒性反应重在预防，基本措施为：①用药前必须证实血象及肾功能正常；治疗前、中、后常规碱化水化处理；②无论MTX剂量如何，都用四氢叶酸解毒；③用药中加强肾功能监测，用药前后均使用保肾药物，一旦出现毒性反应前起症状，除积极对症治疗外，保肾治疗有重要意义；④严禁患者自行使用MTX。
MTX is the most commonly used antineoplastic drug and a second-line drug against autoimmune diseases. Adverse reactions to MTX are many, of which pancytopenia is one of the more serious toxic reactions. The main clinical manifestations of blood down three lines, bone suppression. Often due to complications such as infection and intracranial hemorrhage caused the patient to die. We found that both large, medium and small doses of MTX treatment can produce pancytopenia. MTX excretion mainly through the kidneys, kidney metabolism, the speed and toxicity of the occurrence and severity of a great correlation. Serious toxic reactions to ATFX focus on prevention, the basic measures are as follows: ① blood must be confirmed before treatment and renal function is normal; before treatment, after the treatment of conventional alkaline hydration; ② regardless of MTX dose, are treated with tetrahydrofolate detoxification ; ③ medication to strengthen renal function monitoring, medication before and after use of kidney drugs, once the symptoms appear before the toxic reaction, in addition to positive symptomatic treatment, the treatment of kidney has an important significance; ④ forbidden patients to use their own MTX.