大剂量甲氨喋呤治疗成人急性淋巴细胞白血病血药浓度研究.docxVIP

-大剂量甲氮喋吟治疗成人急性淋巴细胞白血病的血药浓度研究- 申请学位级别：硕士 专业：内科学（血液） 指导教师：江滨中文摘要 大剂量甲氨喋吟治疗成人急性淋貝细胞白血病的血药浓度研究 ) 、 H的 评价大剂量田氨喋吟HDMTX在成人急性淋巴细胞白血病ALL治疗小 血药浓度监测的临床意义 探讨患者临床特征与甲氨喋吟血药浓度 清除率个体差异的 相关性包括患者年龄血清内氨酸氨基转移酶肌肝以及肌肝箱除率 ° o 、 、 方法12例急性淋巴细胞白血病患者接受甲氨喋吟lg/iw治疗 共13例次 在MTX o 输注结束后12小时常规以甲酰四氢叶酸钙解救 分别于给药开始后24h 48h 72h测定 MTX血药浓度计算清除率监测治疗前后血清内氨酸氨基转移就及朋丽血附清除井 P U : 土 U , 结果1 J3例次MTX 24小时静脉输注结束即刻的血药］浓度X SD为12.32 3.64 p mol/L 超朗在(7.58?18.54 ± mol/L) 48h血药浓度为0.32 0.29 mol/L 范鬧 在(Q.Q6?0.85 mol/L) 有3例次72小吋血纱浓度小于0.02 mol/L其余9例在(0.03? 0.21 mol/L) 、MTX清除率为89.06 23.99ml/rpin/m2 范围在 54.952?134.408 ml/min /mz. , 、 o 采用MTX lg/mz本组MTX24R 48h血药浓鹰及清除率与年龄无显著相关 性同样在MTX lg/g下 本组MTX稳态血药浓度清除率与儿童ALL相比无显著差异 3、 本组患者MTX清除率与血清ALT Cr?显著相关 脳血清ALT Cr水平降低而 加快MTX清除率与Ccr?无显著相关性° 4仅有3/13例次MTX稳态血药浓度达到有效阈值7/13例次达到MTX血药浓 度屮毒阈值但均未发生严重毒副反应 Q ( ) 结论 对12例年龄15 52岁肝肾功能基本正第的ALL患者应用MTX lg/g 24h静脉 输注的方案治疗MTX血药浓度及清除率Q年龄尢明显相关性本组3/13例次23.08% 达到文献报道的有效血药浓度7/13例次53.8% 达到文献报道的屮毒阈值 但均未 出现严重毒副反应 我们建议对年龄60岁 肝肾功能正常的ALL患者可在监测血药浓 度肝肾功能基础上可适度提高MTX剂量 关键词甲氨喋吟血药浓度急性白血病淋巴细胞 Abstract The study on plasma concentration of high-dose methotrexate for adult acute lymphoblastic leukemia Object: The purpose of our analysis was to evaluate the clinical significance of MTX plasma concentration and identify the patient characteristics related to the inter- and intra-patient variabilities of MTX plasma concentration and clearance, such as age, SALT, SCr and creatitine clearance. , Methods: Plasma MTX concentration and systemic clearance were determined in 12 adults who received 13 courses of MTX lg/m2 ivtravenous in 24 hours Leucovorin was routinely performed at 12 hours after MTX infusion. SALT and SCr were estimated before MTX administration and 3 days after MTX infusion. Results: MTX steady-state plasma concentrations produced by the intravenous infusion of lg/m? in 24 hours ranged from 7.58pmol/L to 18.54gmol/L, while 48h MTX plasma concentrations from 0.06gmol/L to 0.85gmol/L. 72h MTX plasma concentrations were smaller than 0.21 pmol/L? MTX c