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目的研究急性淋巴细胞白血病(ALL)患儿接受大剂量甲氨蝶呤(MTX)化疗后发生贫血的相关影响因素。方法回顾性分析183例ALL患儿的临床资料,用Ordinal回归分析ALL患儿的性别、年龄、MTX剂量、化疗开始后第24,42 h的MTX血清浓度(C24和C42)与化疗后贫血发生率的相关性。结果在540例次大剂量MTX化疗中,446例次化疗后发生贫血,贫血的发生率为82.59%。多元Ordinal回归分析显示,年龄(P<0.01)、剂量(P<0.05)和C24(P<0.01)与化疗后贫血的发生显著相关,其回归系数估计值分别为0.057,0.487和0.014。结论年龄、剂量和C24与ALL患儿接受MTX化疗后的贫血发生率显著正相关,加强甲氨蝶呤血清浓度监测与甲酰四氢叶酸钙解救,有助于降低贫血的发生率。
Objective To investigate the related factors of anemia in children with acute lymphoblastic leukemia (ALL) receiving high dose methotrexate (MTX) chemotherapy. Methods The clinical data of 183 children with ALL were analyzed retrospectively. The sex, age and MTX dose of ALL children were analyzed by Ordinal regression. The serum levels of MTX (C24 and C42) at 24 and 42 h after chemotherapy were compared with those after chemotherapy Rate of relevance. Results In the 540 high-dose MTX chemotherapy, anemia occurred after 446 chemotherapy cycles. The incidence of anemia was 82.59%. Multivariate Ordinal regression analysis showed that age (P <0.01), dose (P <0.05) and C24 (P <0.01) were significantly correlated with the occurrence of anemia after chemotherapy. The estimated regression coefficients were 0.057, 0.487 and 0.014, respectively. Conclusion Age, dose and the incidence of anemia after MTX chemotherapy are significantly correlated with C24 and ALL. To strengthen the monitoring of methotrexate serum concentration and levofloxacin rescue may help to reduce the incidence of anemia.