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大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病不同解救时间安全性分析

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目的 分析大剂量甲氨蝶呤(High dose methotrexate,HD-MTX)治疗儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)后36小时和42小时应用亚叶酸钙(Calcium Leucovorin,CF)解救的安全性.方法 选取浙江中医药大学附属杭州第一医院2012年9月~2015年12月住院的137例急性淋巴细胞白血病儿童为研究对象,按照本次就诊序号(单号、双号)将137例ALL患儿随机分为A组(n=69)、B组(n=68).治疗例次总数为454例次,其中A组解救时间为36小时,共224例次;B组解救时间为42小时,共230例次,测定观察A组和B组甲氨蝶呤在24、48、96小时的血浆药物浓度、排泄延迟发生率、亚叶酸钙总剂量/甲氨蝶呤总剂量、毒副反应发生率.结果 2组甲氨蝶呤血浆药物浓度在24、48、96小时的血浆药物浓度、排泄延迟发生率、毒副反应发生率方面差异无统计学意义.2组亚叶酸钙总剂量/甲氨蝶呤总剂量差异有统计学意义(P<0.05),A组CF用量显著高于B组.结论 亚叶酸钙解救时间为42 h时,对急性淋巴细胞白血病儿童实施大剂量甲氨蝶呤治疗的疗效最好.
Analysis on safety of different rescue time for children with acute lymphoblastic leukemia treated using high-dose methotrexate
Objective To analyze the safety of high dose methotrexate (HD-MTX) in the treatment of children with acute lymphoblastic leukemia (ALL) after 36 hours and 42 hours using leucovorin (CF) rescue. Methods A total of 137 childhood with acute lymploblastic leukemia(ALL) in our hospital from September 2012 to December 2015 were analysed in this study, 137 children with ALL were randomly divided into group A (n=69) and group B (n=68) according to the serial number (odd number and odd number). The total number of treatment times was 454 times. Among them, the rescue time of group A was 36 hours, there were 224 cases, and the rescue time of group B was 42 hours, 230 times.The plasma drug concentration, delayed excretion rate, the total dose of leucovorin, the total dose of methotrexate and the incidence of side effects were observed in group A and group B at 24, 48 and 96 hours. Results There was no significant difference in plasma concentration, delay of excretion and incidence of side effects between 2 groups of methotrexate, 24, 48 and 96 hours. The total dose of methotrexate/methotrexate in 2 groups was statistically significant (P<0.05). Conclusion When the rescue time of leucovorin was 42h, the treatment of acute lymphoblastic leukemia with high-dose methotrexate was the best.

Children with acute lymphoblastic leukemiaHigh-dose MethotrexateDifferent rescue timesafety

张理科、林能明

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浙江中医药大学附属杭州第一医院 药剂科,浙江 杭州 310000

儿童急性淋巴细胞白血病 大剂量甲氨蝶呤 不同解救时间 安全性

2017

中国生化药物杂志
南京生物化学制药研究所,全国生化制药情报中心站,中国生化制药工业协会,中国药品生物制品检定所

中国生化药物杂志

ISSN:1005-1678
年,卷(期):2017.37(8)
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