摘要
目的探讨血药浓度监测在大剂量甲氨蝶呤（MTX）治疗血液系统肿瘤中的应用价值。方法给予105例急性淋巴细胞白血病及淋巴瘤患者217例次大剂量MTX（1.5-9.0 g）治疗,根据MTX的血药浓度,以不同剂量及不同给药方式给予四氢叶酸钙（CF）解救。于开始用药44 h起,间隔6-12 h用荧光偏振免疫法测定MTX血药浓度,监测至MTX浓度〈0.1μmol/L止。结果6例次（2.8%）患者开始用药44 h后MTX浓度（CMTX/44 h）≥5μmol/L,平均浓度为11.67μmol/L（6.01-20.15μmol/L）,平均解救中止时间为开始用药170 h（92-272 h）;23例次（10.6%）患者1μmol/L≤CMTX/44 h〈5μmol/L,平均浓度为2.23μmol/L（1.07-4.69μmol/L）,平均解救中止时间为开始用药116 h（68-188 h）后。CMTX/44 h≥1μmol/L者基本出现于使用MTX剂量≥5 g的患者中。除个别患者出现轻度黏膜炎症外,所有患者均未发生严重不良发应。结论MTX的代谢过程存在个体差异,应进行血药浓度监测。排泄延迟更易出现于使用高剂量药物时。在血药浓度监测下使用大剂量MTX安全可行。
Objective To explore the clinical value of blood concentration monitoring during high- dose methotrexate （MTX） treatment. Methods High-dose MTX （1.5-9.0 g） was infused to 105 patients with acute lymphoblastic leukemia or lymphoma, and then the blood MTX concentration was measured by fluo- rescence polarization immune assay （FPIA） 44 hours after the start of administration. The procedure was repeated every 6-12 hours until the concentration was less than 0. 1 μmol/L. Results Forty-four hours after the start of administration, the blood MTX concentration （ CMTX/44h） was 〉15 μmoL/L in 6 patients （2.8%） and was between 1 and 5 p, mol/L in 23 patients （ 10.6% ）. CMTX/44h≥1 dmol/L was more common in patients received 5.0 g MTX. No severe adverse event was observed in all patients. Conclusions Blood MTX concentration is different after high-dose MTX treatment due to individual metabolic differences, and therefore it is clinically important to monitor blood concentration of MTX. Elimination delay is more common in patients receive 5.0 g MTX. Application of high-dose MTX therapy under the monitoring of blood MTX concentration is safe and feasible.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2009年第5期564-566,共3页
Acta Academiae Medicinae Sinicae
关键词
甲氨蝶呤
血药浓度
排泄延迟
不良反应
methotrexate
blood concentration
elimination delay
adverse events
