大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的临床观察(1)
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[摘要] 目的 观察大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的疗效与安全性。 方法 观察本院应用大剂量甲氨蝶呤治疗的33例不同程度急性淋巴细胞白血病患儿的治疗效果，监测用药后不同时间点的血药浓度以及用药后的不良反应发生率。 结果 标危组44 h与68 h时的血药浓度分别为(1.12±0.37) μmol/L与(0.41±0.22) μmol/L，中高危组分别为(0.82±0.32) μmol/L与(0.23±0.16) μmol/L，两组68 h时的血药浓度均显著低于44 h时的血药浓度，P < 0.01；两组不良反应与排泄延迟发生率无明显差异，P > 0.05。 结论 应用大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病后，通过血药浓度监测在恰当时间内采取四氢叶酸钙解救可有效提高治疗效果，减轻不良反应程度。
[关键词] 急性淋巴细胞白血病；甲氨蝶呤；疗效观察；儿童
[中图分类号] R725.5 [文献标识码] A [文章编号] 1674-4721(2012)02(b)-0076-02
The clinical observation of the treatment of high-dose methotrexate for children with acute lymphoblastic leukemia
LUO Huashan
The People's Hospital of Meizhou City in Guangdong Province, Meizhou 514031, China
[Abstract] Objective To observe the effect and safety of the treatment of high-dose methotrexate for children with acute lymphoblastic leukemia. Methods Observed the clinical effect of high-dose methotrexate in the treatment of 33 cases of children patients with varying degrees of acute lymphoblastic, monitored plasma concentration of different time points after medication and the incidence of adverse reactions after treatment. Results The plasma concentration of standard risk group in 44 h and 68 h were (1.12±0.37) μmol/L and (0.41±0.22) μmol/L, high-risk group were (0.82±0.32) μmol/L and (0.23±0.16) μmol/L, the plasma concentration of two groups in 68 h were significantly lower than the plasma concentration in 44 h, P < 0.01; Adverse reactions and delayed excretion of two groups were no significant differences, P > 0.05. Conclusion After the application of the treatment of high-dose methotrexate for children with acute lymphoblastic leukemia, through the blood concentration to take leucovorin rescue treatment at the right time can effectively improve the treatment effect, reduce the degree of adverse reactions.
[Key words] Acute lymphoblastic leukemia; Methotrexate; Efficacy observation; Children
急性淋巴细胞白血病(ALL)是儿童急性白血病中比较多见的疾病种类，好发于5岁以下的儿童当中[1]。大剂量甲氨蝶呤(HD-MTX)是ALL联合化疗方案中的重要组成制剂之一，是全身性强化治疗与庇护所治疗的重要方法，对于提高ALL患儿的远期无病生存率至关重要[2] ......
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