CAJ | 학술논문

目的探讨不同时间四氢叶酸钙(CF)解救大剂量甲氨蝶呤(HDMTX)化疗毒副作用的临床效果.方法将符合标准的急性淋巴细胞白血病(ALL)患儿根据化疗例次随机分为两组,观察组为A组.对照组为B组,两组均采用的化疗方案包括诱导缓解治疗(VDLD),巩固治疗(CAT),庇护所预防(HDMTX+CF),再诱导治疗的指导原则.庇护所预防治疗是A组应用大剂量甲氨蝶呤静注24 h结束后,于12 h给予四氢叶酸钙解救治疗.B组应用大剂量甲氨蝶呤静注6 h结束后,于30 h给予四氢叶酸钙解救治疗.观察两组患儿用药后的不良反应,特别是胃肠道反应,即恶心呕吐程度,口腔黏膜反应程度,白细胞反应程度,心、肝、肾、神经毒性反应情况及反应持续时间.结果两组患儿化疗后胃肠道反应程度,口腔黏膜反应程度,白细胞反应程度差异均有统计学意义(P<0.05),且化疗后反应持续时间差异有统计学意义(P<0.01).化疗后心、肝、肾、神经毒性反应差异无统计学意义(P>0.05).结论不同时间四氢叶酸钙解救大剂量甲氨蝶呤化疗毒副反应有差异,两组均可降低毒性反应,但24 h滴注HDMTX后12 h给予CF解救,更有利于正常组织细胞损伤的修复,提高化疗效果和患儿生存质量和生存率,具有较好的临床应用价值.
목적 탐토불동시간사경협산개(CF)해구대제량갑안접령(HDMTX)화료독부작용적림상효과.방법 장부합표준적급성림파세포백혈병(ALL)환인근거화료례차수궤분위량조,관찰조위A조.대조조위B조,량조균채용적화료방안포괄유도완해치료(VDLD),공고치료(CAT),비호소예방(HDMTX+CF),재유도치료적지도원칙.비호소예방치료시A조응용대제량갑안접령정주24 h결속후,우12 h급여사경협산개해구치료.B조응용대제량갑안접령정주6 h결속후,우30 h급여사경협산개해구치료.관찰량조환인용약후적불량반응,특별시위장도반응,즉악심구토정도,구강점막반응정도,백세포반응정도,심、간、신、신경독성반응정황급반응지속시간.결과 량조환인화료후위장도반응정도,구강점막반응정도,백세포반응정도차이균유통계학의의(P<0.05),차화료후반응지속시간차이유통계학의의(P<0.01).화료후심、간、신、신경독성반응차이무통계학의의(P>0.05).결론 불동시간사경협산개해구대제량갑안접령화료독부반응유차이,량조균가강저독성반응,단24 h적주HDMTX후12 h급여CF해구,경유리우정상조직세포손상적수복,제고화료효과화환인생존질량화생존솔,구유교호적림상응용개치.
Objective To explore the clinical effects of calcium folinate(CF)rescue on high-dose methotrexate (HDMTX)therapy at different times.Methods Children with acute lymphocytic leukemia(ALL)who met the inclusion criteria were randomly divided into two groups in line with chemotherapy order:observation group(Group A)and control group(Group B).Chemotherapy regimens included remission induction chemotherapy(VDLD),consolidation therapy(CAT),shelters to prevent(HDMTX+CF),reinduction therapy.Group A was intravenously injected HDMTX for 24 hours and then rescued by CF for 12hours.Group B was intravenously injected HDMTX for 6 hours and then rescued by CF for 30 hours.Side effects after administration of medicine were observed,in particular,the gastrointestinal tract reaction,which included nausea and vomiting,oral mucous membrane reaction,leukocyte reaction,the toxicity of the heart,liver,kidney,nerve and response durations.Results There were significant differences in both groups on response degree in the gastrointestinal tract reaction,oral mucous membrane reaction,and leukocyte reaction (P<0.01,P<0.05);while there was significant difference in response duration after chemotherapy for both groups(P<0.01).There was no significant difference in the heart,liver,kidney,neurological toxicity reaction(P>0.05).Conclusions There are differences in side effects of CF rescue on HDMTX therapy at different times.Both groups could reduce the toxic reaction,but the protocol that gives HDMTX for 24 hours and then rescues by CF for 12 hours is more conducive to repair the normal tissue cell's damage,improve chemotherapy efficacy and children's quality of life,with a better clinical value.