CAJ | 학술논문

目的急性淋巴细胞白血病完全缓解期患儿应用大剂量甲氨喋呤(HD-MTX)进行庇护所治疗,通过MTX浓度的检测及时调整亚叶酸钙解救方案的研究,从而降低MTX的毒性反应,为临床提供一种安全有效的化疗方案.方法220例急性淋巴细胞白血病患儿处于完全缓解期,根据临床分型,分别给予MTX 3.0g/㎡(标危)-5.0g/㎡(中、高危),加三联鞘注一次,MTX静滴42小时开始亚叶酸钙解救,15mg/㎡/次,iv 共3次,分别在第42h,48h,54h统一按15mg/㎡解救,于44h,48h,66h进行MTX血药浓度检测,根据浓度结果进行不同剂量CF的解救,观察患儿的MTX毒性反应程度.结果10例患儿出现口腔粘膜损害,占同期化疗患儿的8.33%,其中3度5例,4度5例；2例患儿伴有肝肾功能损害,占同期化疗患儿的1.67%.15例患儿分别给予抗感染治疗及人免疫球蛋白、集落细胞刺激因子、成分输血,3例伴有粒细胞,减少患儿给予支持治疗,同时加强口腔护理,均于治疗后8-10天体温正常,3周痊愈.结论 MTX血药浓度监测及合理的亚叶酸钙解救方案可减少HD-MTX化疗毒副反应,是一种治疗ALL安全有效的化疗方案.
목적급성림파세포백혈병완전완해기환인응용대제량갑안첩령(HD-MTX)진행비호소치료,통과MTX농도적검측급시조정아협산개해구방안적연구,종이강저MTX적독성반응,위림상제공일충안전유효적화료방안.방법220례급성림파세포백혈병환인처우완전완해기,근거림상분형,분별급여MTX 3.0g/㎡(표위)-5.0g/㎡(중、고위),가삼련초주일차,MTX정적42소시개시아협산개해구,15mg/㎡/차,iv 공3차,분별재제42h,48h,54h통일안15mg/㎡해구,우44h,48h,66h진행MTX혈약농도검측,근거농도결과진행불동제량CF적해구,관찰환인적MTX독성반응정도.결과10례환인출현구강점막손해,점동기화료환인적8.33%,기중3도5례,4도5례；2례환인반유간신공능손해,점동기화료환인적1.67%.15례환인분별급여항감염치료급인면역구단백、집락세포자격인자、성분수혈,3례반유립세포,감소환인급여지지치료,동시가강구강호리,균우치료후8-10천체온정상,3주전유.결론 MTX혈약농도감측급합리적아협산개해구방안가감소HD-MTX화료독부반응,시일충치료ALL안전유효적화료방안.
Objective Give shelter treatment to the children in acute lymphoblastic leukemia complete remission period,detect the concentration of MTX and adjust the calcium folinate(CF) rescue to reduce the toxic reactivity of MTX,in order to afford an safe and efective Chemotherapy regimen.Methods All of the 220 ALL patients were in complete remission period,gave MTX 3.0g/m2(Standard risk)-5.0g/m2(high risk) respectively, then ongoing Triple intrathecal injection once,used calcium folinate(15mg/m2/次,intravenously,three times at 42h,48h,54h time points) 42 hours later , The plasma concentration of methotrexate was monitored at 44h,48h,66h time points,and a reasonable times for folate rescue was adjusted according to the plasma methotrexate concentration. Adverse effects were recorded after HD-MTX chemotherapy. Results Oral mucosal erosions was found in 10 of the ALL patients,which including 5 of grade III,5 of grade IV;the ratio by the patients undergoing HD-MTX chemotherapy was 8.33%,abnormal liver and renal function was found in 2 of the ALL patients,the ratio by the patients undergoing HD-MTX chemotherapy was 1.67%.15 of the ALL patients accepted the anti - infective treatment、immunoglobulin、colony stimulating factor(CSF)、partial blood transfusion,3 of the ALL patients accompanied with aplastic anemia received supportive treatment and cavity nurses,the temperture got back to normal 8 to 10 days after the treatment,recovered in 3 weeks.Conclusions The individual CF rescue was implemented under the monitoring of plasma methotrexate concentrations in order to achieve an safe and effective anti-tumor effect and avoid the serious adverse effect.