大剂量甲氨蝶呤致MTHFR突变患者甲氨蝶呤排泄延迟及肝损害1例
Methylenetetrahydrofolate reductase mutation with delayed methotrexate excretion and liver damage caused by high-dose methotrexate:one case report
李晓 1全香花 1徐文 1张小蕾 1李静1
作者信息
- 1. 青岛大学附属医院药学部,山东青岛 266003
- 折叠
摘要
该文介绍1例MTX代谢和排泄基因突变的儿童ALL患者在接受HD-MTX化疗后联合应用PPI和青霉素类药物导致肝损害的过程.该案例可为存在MTX代谢和排泄基因突变的患者以及类似联合用药患者提供一定的参考.通过该案例,建议患者在应用HD-MTX化疗前进行MTX用药基因检测,根据基因检测结果提前适当增减HD-MTX 的用量,密切监测血药浓度,减少或避免联合应用PPI和青霉素类等可能影响MTX排泄的药物,避免发生MTX排泄延迟或毒副反应.
Abstract
This report described the process of liver dam-age caused by a combined dosing of proton pump inhibitor(PPI)and penicillin in an ALL child with MTX metabolism and excretion gene mutations after receiving high-dose metho-trexate(HD-MTX)chemotherapy.It provided some refer-ence for patients with MTX metabolism and excretion gene mutations,as well as similar combination therapy patients.Therefore methylenetetrahydro folate reductase(MTHFR)C677T,MTHFR A1298C and ABCB1 C3435T genotyping are recommended to perform before HD-MTX chemo-therapy.Based upon the results of genotypic analyses,the dosage of HD-MTX should be appropriately adjusted in advance.Blood concentration of MTX should be closely monitored for avoiding a combined dosing of PPI and penicil-lin potentially affecting MTX excretion to prevent delayed MTX excretion or adverse drug reaction.
关键词
大剂量甲氨蝶呤/排泄延迟/肝损害/基因多态性/联合用药Key words
high-dose methotrexate/delayed excretion/liver damage/genetic polymorphism/drug combination引用本文复制引用
出版年
2024
NETL
NSTL
万方数据