大剂量甲氨蝶呤治疗毒副作用系统分析

发布时间：2018-03-18 19:56

本文选题：甲氨蝶呤　切入点：副作用　出处：《中国当代儿科杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的总结大剂量甲氨蝶呤(HDMTX)治疗的毒副作用,为优化HDMTX治疗提供理论基础。方法回顾性分析601例次接受HDMTX治疗的120例急性淋巴细胞白血病或非霍奇金淋巴瘤患儿临床资料,按照WHO抗癌药物毒副作用分级标准对各系统毒副作用进行分析。结果 HDMTX治疗后骨髓抑制几乎出现在所有患儿,以粒细胞减少最为多见(93.3%)。最常见的消化系统毒副作用是谷丙转氨酶升高(60.4%);泌尿系统最常见的毒副作用是蛋白尿(9.2%);皮肤症状发生率最高的为皮肤红斑(7.2%);神经系统毒副作用如痛觉过敏、肢体麻木或头痛仅观察到7例次。HDMTX的严重毒副作用仅见于血液系统和消化系统。与MTX3 g/m2组比较,5 g/m2 HDMTX组的24 h MTX血药浓度较高(P0.05),血红蛋白及血小板降低、口腔黏膜炎、蛋白尿和皮肤症状等毒副作用的发生率也较高(P0.05)。结论 HDMTX治疗后严重毒副作用主要发生在血液系统和消化系统,骨髓抑制、口腔黏膜炎、蛋白尿、皮肤症状等毒副作用的发生均有一定的剂量依赖性。
[Abstract]:Objective to summarize the toxic and side effects of high dose methotrexate HDMTX in order to provide a theoretical basis for optimizing the treatment of HDMTX. Methods the clinical data of 601 children with acute lymphoblastic leukemia or non-Hodgkin 's lymphoma treated with HDMTX were retrospectively analyzed. According to the WHO criteria for the classification of toxicity and side effects of anticancer drugs, the toxicity and side effects of each system were analyzed. Results Bone marrow suppression appeared in almost all children after HDMTX treatment. The most common toxic side effects of alanine aminotransferase are alanine aminotransferase (alanine aminotransferase) 60.4m; urinary system is the most common side effect is proteinuria 9.2G; the highest incidence of skin symptoms is the skin erythema 7.2B; nervous system toxicity. Side effects such as hyperalgesia, Severe side effects of HDMTX were observed only in the blood system and digestive system in 7 patients with limb numbness or headache. Compared with the MTX3 gr / m 2 group, the 24 h MTX concentration in the 5 g / m 2 HDMTX group was higher than that in the 5 g / m 2 HDMTX group (P 0.05), hemoglobin and platelet reduction, oral mucositis, hemoglobin and thrombocytopenia, and oral mucositis. The incidence of toxic side effects such as proteinuria and skin symptoms is also higher than that of P0.050.Conclusion the severe side effects after HDMTX treatment are mainly in the blood system and digestive system, bone marrow suppression, oral mucositis, proteinuria, etc. The occurrence of toxic side effects such as skin symptoms was dose dependent.
【作者单位】：北京大学第一医院儿科;
【分类号】：R733

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