CAJ | 학술논문

目的：通过监测甲氨蝶呤血药浓度指导急性淋巴细胞白血病（ALL）患者的大剂量甲氨蝶呤（HD-MTX）化疗和解救方案，保证用药合理、有效、安全。方法①将30例次HD-MTX化疗的ALL患者按甲氨蝶呤剂量不同分组，每组15例次，Ⅰ组3g/m2，Ⅱ组5g/m2。用高效液相色谱法（ HPLC法）测定化疗结束后0、20、44h（必要时追加68h、92h采血点）所测得的血药浓度监测，指导亚叶酸钙（ CF）解救，同时观察患者不良反应和Ⅰ组、Ⅱ组两组化疗前后患者肝肾功能各项指标的变化。②按照①中HPLC法所测得的甲氨蝶呤血药浓度将30例ALL患者分为排泄延迟组和非排泄延迟组，并分析甲氨蝶呤排泄延迟与不良反应之间的联系。结果①于0、20和44h时，高剂量Ⅱ组的血药浓度均比低剂量Ⅰ组血药浓度高。相应的是，高剂量Ⅱ组各种不良反应发生率也较低剂量Ⅰ组高；②排泄延迟组肝肾功能异常的比例明显比非排泄延迟组高。结论甲氨蝶呤的血药浓度监测可提高治疗用药安全性和有效性，对CF个体化解救、减少不良反应的发生具有十分重要的意义。
목적：통과감측갑안접령혈약농도지도급성림파세포백혈병（ALL）환자적대제량갑안접령（HD-MTX）화료화해구방안，보증용약합리、유효、안전。방법①장30례차HD-MTX화료적ALL환자안갑안접령제량불동분조，매조15례차，Ⅰ조3g/m2，Ⅱ조5g/m2。용고효액상색보법（ HPLC법）측정화료결속후0、20、44h（필요시추가68h、92h채혈점）소측득적혈약농도감측，지도아협산개（ CF）해구，동시관찰환자불량반응화Ⅰ조、Ⅱ조량조화료전후환자간신공능각항지표적변화。②안조①중HPLC법소측득적갑안접령혈약농도장30례ALL환자분위배설연지조화비배설연지조，병분석갑안접령배설연지여불량반응지간적련계。결과①우0、20화44h시，고제량Ⅱ조적혈약농도균비저제량Ⅰ조혈약농도고。상응적시，고제량Ⅱ조각충불량반응발생솔야교저제량Ⅰ조고；②배설연지조간신공능이상적비례명현비비배설연지조고。결론갑안접령적혈약농도감측가제고치료용약안전성화유효성，대CF개체화해구、감소불량반응적발생구유십분중요적의의。
OBJECTIVE To ensure the use of medication reasonable ,offective and safe by therapeutic drug mo-nitoring of high-dose methotrexate in pediatric acute lymphoblastic leukemia and assessing the clinical signifi -cance.METHODS ①30 acute lymphoblastic leukemia patients were grouped according to the dosage of methotrex-ate:the high dosage group received MTX 5.0g/m2 and the low dosage group received MTX 3.0g/m2.The MTX con-centration in serum at 0,20,44(68h,92h p.r.n) were detected by high performance liquid chromatography (HPLC).Then adjust the dosage of CF according to MTX concentration and observe the adverse effects of MTX in patients .②patients were grouped elimination delay group and no-elimination delay group according to MTX concentration by high performance liquid chromatography (HPLC) from①,then analyze the relationship between elimination delay of methotrexate and adverse reaction.RESULTS ①The concentration of MTX at 20 ,44 of high dosage group were higher than the concentration of MTX at 20,44 of low dosage group,respectively.And,the occurrence of adverse re-actions of high dosage group is also higher than low dosage group;②The proportion of abnormity of hepatorenal func-tion in elimination delay group is obviously higher than no-elimination delay group.CONCLUSION To Monitoring the concentration of MTX can enhance safety and effectiveness of medication use ,which has clinical significance.For CF individual rescueing and the occurrence of adverse reactions reducing.