CAJ | 학술논문

目的：探讨大剂量甲氨蝶呤（ methotrexate，MTX）治疗急性淋巴细胞白血病（ acute lymphoblastic leukemia，ALL）和淋巴瘤的血药浓度监测的临床意义，并统计分析其不良反应。方法选择44例急性淋巴细胞白血病及淋巴瘤患者，使用大剂量甲氨蝶呤（ high-dose methotrexate，HD-MTX）后，采用酶放大免疫法测定其血药浓度，观察不良反应发生情况，分析儿童与成人不良反应的区别。结果与成人组比较，儿童组的胃肠道反应和黏膜损伤发生率更高，差异有统计学意义（ P＜0.05）；CMTX48 h＞0.4μmol／L者的骨髓抑制及胃肠道反应发生率高于CMTX48 h≤0.4μmol／L者，两组之间差异有统计学意义（P＜0.05）。结论 MTX不良反应主要为骨髓抑制、胃肠道反应及黏膜损伤；儿童的胃肠道反应和黏膜损伤发生率高于成人；通过监测MTX的血药浓度有助于及时适量调整甲酰四氢叶酸钙（ calcium folinate，CF）解救量，确保临床用药安全有效。
목적：탐토대제량갑안접령（ methotrexate，MTX）치료급성림파세포백혈병（ acute lymphoblastic leukemia，ALL）화림파류적혈약농도감측적림상의의，병통계분석기불량반응。방법선택44례급성림파세포백혈병급림파류환자，사용대제량갑안접령（ high-dose methotrexate，HD-MTX）후，채용매방대면역법측정기혈약농도，관찰불량반응발생정황，분석인동여성인불량반응적구별。결과여성인조비교，인동조적위장도반응화점막손상발생솔경고，차이유통계학의의（ P＜0.05）；CMTX48 h＞0.4μmol／L자적골수억제급위장도반응발생솔고우CMTX48 h≤0.4μmol／L자，량조지간차이유통계학의의（P＜0.05）。결론 MTX불량반응주요위골수억제、위장도반응급점막손상；인동적위장도반응화점막손상발생솔고우성인；통과감측MTX적혈약농도유조우급시괄량조정갑선사경협산개（ calcium folinate，CF）해구량，학보림상용약안전유효。
Objective To investigate the clinical significance of plasma concentration monitoring after high-doses of methotrex-ate( HD-MTX) in the treatment of acute lymphoblastic leukemia and lymphoma,and statistical analysis of its adverse reactions.Meth-ods The plasma concentrations of 44 patients with acute lymphoblastic leukemia and lymphoma were measured by an enzyme multi-plied immunoassay technique( EMIT) .Their adverse reactions were observed.Results The incidence of gastrointestinal reaction and mucosa injury were significantly less in adults than that in children( P<0.05) .Meanwhile,the incidence of myelosuppression and gas-trointestinal reaction were significantly less in group with CMTX48 h≤0.4μmol/L than that in group with CMTX48 h>0.4 μmol/L(P<0.05).Conclusion The adverse reactions of HD-MTX were mainly the gastrointestinal reaction,myelosuppression and mucosa inju-ry.The incidence of gastrointestinal reaction and mucosa injury were less in adults than that in children.The monitoring of concentration of MTX in plasma can contribute to appropriately adjust the use of CF and ensure the security and effect of MTX.