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1例21岁男性何杰金淋巴瘤患者,在母供髓干细胞移植前用甲氨蝶呤3.0g,异环磷酰胺2.0g,吉西他滨1.0g,长春瑞宾20mg,波替单抗2.05mg,L-门冬酰胺酶10000U,泼尼松100mg联合化疗。24h后出现少尿,SCr246μmol/L,BUN16.3mmol/L,尿酸497mmol/L。36h甲氨蝶呤血药浓度为25μmol/L。肾部超声检查示肾脏密度分布欠均匀,右上极可见2.1cm×2.3cm无回声液区。诊断:急性肾损害。给予四氢叶酸钙200mg/3h,加强水化、碱化尿液及血液透析。患者甲氨蝶呤血药浓度下降,SCr、BUN逐渐恢复正常。分析其母亲外周血淋巴细胞、患者外周血淋巴细胞、患者口腔上皮细胞亚甲基四氢叶酸还原酶C677T基因型示C:T分别为1:1、1:1和1:1.5,提示患者的肾损害可能与基因型有关。
A 21-year-old male patient with Hodgkin’s lymphoma received methotrexate 3.0 g, ifosfamide 2.0 g, gemcitabine 1.0 g, vinorelbine 20 mg, bortezomib 2.05 mg, L-asparaginase 10000U, prednisone 100mg combined with chemotherapy. After 24h oliguria, SCr246μmol / L, BUN16.3mmol / L, uric acid 497mmol / L. 36h methotrexate blood concentration of 25μmol / L. Renal ultrasound showed renal density distribution is not uniform, right upper visible 2.1cm × 2.3cm no echo area. Diagnosis: Acute kidney damage. Give calcium folinate 200mg / 3h, to strengthen the hydration, alkalinization of urine and hemodialysis. Patients methotrexate plasma concentration decreased, SCr, BUN gradually returned to normal. Analysis of the mother’s peripheral blood lymphocytes, peripheral blood lymphocytes in patients with oral epithelial cells methylenetetrahydrofolate reductase C677T genotype showed C: T were 1: 1, 1: 1 and 1: 1.5, suggesting that patients Kidney damage may be related to genotypes.