成人大剂量甲氨蝶呤治疗后排泄延迟因素的分析

发布时间：2018-09-18 09:41

【摘要】：目的通过对接受大剂量甲氨蝶呤(HD-MTX)化疗患者血药浓度及尿常规和肾功能等指标进行监测,分析MTX排泄延迟的影响因素,为指导HD-MTX化疗提供参考。方法对2008年9月-2013年7月136例次接受HD-MTX化疗患者的血清药物浓度、尿pH值和肾功能进行监测,并对可能的相关因素进行统计学分析。结果共检测MTX血药浓度214次,发生排泄延迟共41次(30.1%),43例患者在治疗中发生1次排泄延迟的有11例,发生2次排泄延迟的有7例,发生3次以上排泄延迟的有4例。排泄延迟的危险因素有MTX的用量、开始化疗后24h尿常规pH值,14例次开始化疗后24h尿常规pH为7.5,均未发生排泄延迟。结论在HD-MTX治疗后,在进行亚叶酸钙(CF)解救的同时要配合好碱化和水化,也要对患者血清MTX浓度、尿PH值和肾功能进行监测,发生排泄延迟时及时调整CF解救剂量并加强碱化和水化可减少不良反应发生,必要时需行血液透析。
[Abstract]:Objective to analyze the influencing factors of delayed excretion of MTX in patients with high dose methotrexate (HD-MTX) by monitoring their blood concentration urine routine and renal function so as to provide reference for guiding HD-MTX chemotherapy. Methods Serum drug concentration, urinary pH and renal function were monitored in 136 patients with HD-MTX from September 2008 to July 2013, and the related factors were analyzed statistically. Results the serum concentration of MTX was detected 214times, and the excretion delay was 41 times (30.1%) in 43 patients. In the treatment, there were 11 cases with one excretion delay, 7 cases with two excretion delay, and 4 cases with more than 3 times of excretion delay. The risk factor of excretion delay was the dosage of MTX. The pH value of urine routine 24 hours after chemotherapy was 7.5 in 14 patients, and no excretion delay occurred. Conclusion after HD-MTX treatment, calcium folate (CF) rescue should be carried out in combination with alkali and hydration, and the serum MTX concentration, urinary PH and renal function should be monitored. Timely adjustment of CF rescue dose and reinforcement of alkalization and hydration can reduce adverse reactions when excretion delay occurs. Hemodialysis is necessary.
【作者单位】：中国医科大学附属盛京医院血液病治疗中心;
【基金】：辽宁省科学技术计划项目(No.2010225032) 沈阳市高技术产业发展项目[No.沈发改发2010(106)]
【分类号】：R96

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