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·医院药学 · 大剂量甲氨蝶呤治疗小儿急性淋巴细胞白血病的血药浓度与不良反 应相关性探讨 魏筱华，郑雪莲，邹德琴，蔡军(南昌大学第一附属医院药剂科，南昌 330006) 摘要：目的 探讨大剂量甲氨蝶呤(MTX)治疗儿童急性淋巴细胞白血病血药浓度与不良反应相关性，为临床合理用药提 供依据。方法 采用荧光偏振免疫法测定 72 位患儿血药浓度，结合临床不良反应观察，采用 χ2 检验分析血药浓度与不 良反应发生的关系。结果 血清 MTX C24 h ≥40 μmol·L1 的常见不良反应发生率与血清 MTX C24 h40 μmol·L1 相比有显 著性差异(P0.05) 。血清 MTX C48 h ≥1.0 μmol·L1 的不良反应发生率与血清 MTX C48 h1.0 μmol·L1 相比有极显著性差异 (P0.01) 。结论 MTX 不良反应的发生率直接取决于 MTX 血药浓度的高低和持续时间的长短。 关键词：甲氨蝶呤；急性淋巴细胞白血病；血药浓度；不良反应 中图分类号：R969.3 文献标志码：B 文章编号：1007-7693(2011)01-0079-03 The Relationship between the Plasma Concentrations and Adverse Reactions of High Dose Methotrexate Used in the Treatment of Pediatric Acute Lymphoblastic Leukemia WEI Xiaohua, ZHEN Xuelian, ZOU Deqin, CAI Jun(Department of Pharmacy, The First Affiliated of Nanchang University, Nanchang 330006, China) ABSTRACT: OBJECTIVE To investigate the relationship between the plasma concentration and adverse reactions of high dose methotrexate (MTX) used in the treatment of pediatric acute lymphoblastic leukemia. METHODS The concentration of MTX in plasma samples of 72 patients were measured by a flurorescence polarization immunoassay, which were analyzed combined with the clinical manifestions by Chi-square test. RESULTS When the MTX C24 h ≥40 μmol·L1, the incidence rates of adverse reaction were higher than those of MTX C24 h40 μmol·L1(P0.05). When the MTX C48 h ≥1.0 μmol·L1, the incidence rates of adverse reaction were higher than those of MTX C48 h1.0 μmol·L1 (P0.01). CONCLUSION The incidence rates and the severity of adverse reactions of high dose MTX were ralated directly with the level and the persistence time of the plasma concentration. KEY WORDS: methotrexate; acute lymphoblastic leukemia; plasma concentration; adverse reaction 大剂量甲氨蝶呤(methotrexate, MTX)加四氢叶 72 例，男 40 例，女 32 例，平均年龄(7.0