摘要
目的 考察小儿急性淋巴细胞白血病大剂量甲氨蝶呤（MTX）化疗时MTX血药浓度的变化规律，为临床制定个体化给药方案提供依据。方法 以接受66例次2．0～4．0g·m^-1的大剂量MTX化疗的小儿急性淋巴细胞白血病患者为研究对象，给药后定时采血测定血药浓度，根据消除末端血药浓度结果决定甲酰四氢叶酸钙（CF）救援方案，观察不良反应进行安全性评价。结果 MTX化疗后同一时间不同个体间血药浓度水平差异较大，尤以消除末端血药浓度差异显著。12例患儿MTX剂量从3．0g·m^-1增至4．0g·m^-1时，初始血药浓度（0～24h）随给药剂量增加而升高，而消除末端的血药浓度（44h以后）与MTX给药剂量无显著相关性，所有病例无不可逆的严重不良反应发生。结论 大剂量MTX化疗时，有必要进行血药浓度监测，以制定个体化给药方案，从而将MTX剂量增至患儿可耐受剂量。消除末端（44h以后）是血药浓度监测的主要取血点。
OBJECTIVE To give clinical reference to determine individual remedy, the metabolic regularity of methotrexate （MTX） were studied. METHODS 27 acute lymphoblastie leukemia children received 66 courses HD-MTX （2.0 - 4.0 g·m^-1） treatment were involved in this study. The serum samples were collected at different time after infusion started. The eitrovorum factor rescue schema were determined with the result of MTX serum concentration in terminal elimination phase. The adverse reaction were also monitored to evaluate the remedy safety. RESULTS MTX concentration in serum had great imparity among individuals, especially with the serum concentration of terminal phase. When MTX dosage of 12 patients increased from 3.0g·m^-1 to 4.0g·m^-1 , the concentration of the initial phase（0h- 24h） increased with MTX dosage added, but the concentration of the terminal phase（ after 44h） showed no correlation with MTX dosage. No severe irreversible adverse reaction were observed. CONCLUSION It＇s necessary to determine individual remedy by serum concentration monitoring for adding MTX dosage to the extent that can be tolerated by ALL children. Terminal phase（ after 44h） should be taken more care about in the therapeutic drug monitoring.
出处
《中国现代应用药学》
CAS
CSCD
北大核心
2006年第6期508-510,共3页
Chinese Journal of Modern Applied Pharmacy
关键词
血药浓度监测
甲氨蝶呤
白血病
儿童
个体化用药
serum concentration monitoring
methotrexate
leukemia
children
individual administrating
