CAJ | 학술논문

目的：对大剂量甲氨蝶呤（High dose methotrexate，HD-MTX）治疗骨肉瘤患者的血药浓度进行动态监测，并探讨其临床意义。方法采用均相酶免疫分析法对接受HD-MTX化疗的10例骨肉瘤患者按照需要定时测定甲氨蝶呤的浓度，分析各时间点 MTX血药浓度特点及其与不良反应之间的关系。结果测得MTX0h平均峰浓度为（9.4737±3.9473）×104 moL· L1，72h平均峰浓度为（9.2743±5.0516）×108 moL· L 1，其中2例的24hMTX血药浓度和1例48hMTX血药浓度大于中毒浓度，有两例出现毒副反应，对四氢叶酸钙（ CF）加大剂量、延长用药时间后，症状消失，所有患者均未发生严重不良发应。结论不同患者MTX各时间点的浓度存在个体差异，应进行血药浓度监测。在血药浓度监测下，及时根据病人实际情况调整CF的解救时间与剂量，使HD-MTX治疗安全可行。
목적：대대제량갑안접령（High dose methotrexate，HD-MTX）치료골육류환자적혈약농도진행동태감측，병탐토기림상의의。방법채용균상매면역분석법대접수HD-MTX화료적10례골육류환자안조수요정시측정갑안접령적농도，분석각시간점 MTX혈약농도특점급기여불량반응지간적관계。결과측득MTX0h평균봉농도위（9.4737±3.9473）×104 moL· L1，72h평균봉농도위（9.2743±5.0516）×108 moL· L 1，기중2례적24hMTX혈약농도화1례48hMTX혈약농도대우중독농도，유량례출현독부반응，대사경협산개（ CF）가대제량、연장용약시간후，증상소실，소유환자균미발생엄중불량발응。결론불동환자MTX각시간점적농도존재개체차이，응진행혈약농도감측。재혈약농도감측하，급시근거병인실제정황조정CF적해구시간여제량，사HD-MTX치료안전가행。
OBJECTIVE To monitor the plasma concentration of high-dosage of methotrexate ( HD-MTX) dur-ing chemotherapy in the treatment of patients with osteosarcoma and discuss its clinical significance MEHTODS Ten patients with osteosarcoma who received high dosages of MTX (6g/m2 ) involved in our study.The serum con-centration of MTX was determined according to need at each time point by fluorescence polarization immune assay ( FP IA ) .The relationship between the serum concentration of MTX and the adverse reaction was ana-lyzed.RESULTS The average peak concentration of MTX 0 h was ( 9.4737 ±3.9473 ) ×10 -4 moL · L-1 and the average peak concentration of MTX 72 h was ( 9.2743 ±5.0516 ) ×10 -8 moL · L-1 and.Among them two patients plasma concentration of MTX 24 h and one patient plasma concentration of MTX 48 h were greater than toxic concen-tration,there were two cares of adverse reaction.These symptoms were disappeared after increasing the dose of CF and prolonging treatment.No severe adverse event was observed in all patients.CONCLUSION There is significant variability in the MTX serum levels , and therefore it is clinically important to monitor blood concentration of MTX.App lication of high-dose MTX therapy under the monitoring of blood and MTX concentration is safe and feasi-ble.