小儿急性淋巴细胞白血病HDMTXCF治疗方案的血药浓度监测分析_药学论文.doc免费

小儿急性淋巴细胞白血病HDMTXCF治疗方案的血药浓度监测分析_药学论文 小儿急性淋巴细胞白血病HDMTXCF治疗方案的血药浓度监测分析_药学论文 作者：王来成，薛天阳，吕冬梅，韩强 【摘要】 目的：通过对大剂量甲氨蝶呤（HDMTX）治疗小儿急性淋巴细胞白血病血药浓度的分析，探讨甲氨蝶呤血药浓度监测的临床意义。方法：采用荧光偏振免疫法（FPIA）监测接受大剂量甲氨蝶呤化疗的32例急性淋巴细胞白血病患儿血药浓度。结果：在应用HDMTX开始后72 h、90 h时MTX血药浓度的变异系数分别为211.76%、128.57%；应用后72 h血药浓度大于1 μmol/L有4例；应用后90 h血药浓度大于0.1 μmol/L 2例且患儿出现了口腔粘膜溃疡。所有患儿无不可逆的严重不良反应。结论：患儿应用MTX后血药浓度个体差异较大，通过血药浓度监测可以调整甲酰四氢叶酸钙（CF）的解救时间和剂量，有效防止严重不良反应的发生，保证化疗的有效性和安全性。 【关键词】 甲氨蝶呤；血药浓度监测；急性淋巴细胞白血病 ［Abstract］ Objective:To explore the clinical significance of monitoring the serum concentration of methotrexate in highdose methotrexate (HDMTX) treatment for children with acute lymphoblastic leukemia. Methods:32 children with acute lymphoblastic leukemia who received HDMTX were involved in this study and the concentrations of MTX were tested by fluorescence polarization immunoassay. The blood samples were collected timely and the blood serum concentration of MTX was determined. Results: 72 h and 90 h after the application of HDMTX, the coefficient of variation for serum MTX concentration was 211.76%, 128.57%,respectively. 72 h after application, there were 4 cases with serum concentration gt;1 μmol/L; 90 h after application there were 2 cases with serum concentration gt;0.1 μmol/L having serious oral mucosal ulcers. None of serious irreversible adverse effects were observed among all children.Conclusions:MTX concentration in serum had great difference between individuals, though a few children appeared the excretion retarded. A close monitoring of the serum concentration helps in timely adjustment of the saving time and the dosage of calcium folinate (CF), avoid serious adverse reaction and ensure the efficacy and safety of the chemotherapy. ［Key words］ Methotrexate; Serum concentration monitoring; Acute lymphoblastic leukemia 近十年来，在治疗小儿急性淋巴细胞白血病（ALL）化疗方案中，大剂量甲氨蝶呤（HDMTX）联合鞘内注射（IT）能有效防治髓外白血病（CNSL）和睾丸白血病（TL）［1,2］，已被临床广泛应用，其有效性也已得到充分肯定。本文对32例（95例次）急性淋巴细胞白血病患儿的MTX血药浓度进行监测，探讨血药浓度与个体化甲酰四氢叶酸钙（CF）解救方案及毒副作用的关系，以期为临