本文選題：甲氨蝶呤　切入點(diǎn)：副作用　出處：《中國(guó)當(dāng)代兒科雜志》2017年07期 　論文類型：期刊論文

【摘要】：目的總結(jié)大劑量甲氨蝶呤(HDMTX)治療的毒副作用,為優(yōu)化HDMTX治療提供理論基礎(chǔ)。方法回顧性分析601例次接受HDMTX治療的120例急性淋巴細(xì)胞白血病或非霍奇金淋巴瘤患兒臨床資料,按照WHO抗癌藥物毒副作用分級(jí)標(biāo)準(zhǔn)對(duì)各系統(tǒng)毒副作用進(jìn)行分析。結(jié)果 HDMTX治療后骨髓抑制幾乎出現(xiàn)在所有患兒,以粒細(xì)胞減少最為多見(jiàn)(93.3%)。最常見(jiàn)的消化系統(tǒng)毒副作用是谷丙轉(zhuǎn)氨酶升高(60.4%);泌尿系統(tǒng)最常見(jiàn)的毒副作用是蛋白尿(9.2%);皮膚癥狀發(fā)生率最高的為皮膚紅斑(7.2%);神經(jīng)系統(tǒng)毒副作用如痛覺(jué)過(guò)敏、肢體麻木或頭痛僅觀察到7例次。HDMTX的嚴(yán)重毒副作用僅見(jiàn)于血液系統(tǒng)和消化系統(tǒng)。與MTX3 g/m2組比較,5 g/m2 HDMTX組的24 h MTX血藥濃度較高(P0.05),血紅蛋白及血小板降低、口腔黏膜炎、蛋白尿和皮膚癥狀等毒副作用的發(fā)生率也較高(P0.05)。結(jié)論 HDMTX治療后嚴(yán)重毒副作用主要發(fā)生在血液系統(tǒng)和消化系統(tǒng),骨髓抑制、口腔黏膜炎、蛋白尿、皮膚癥狀等毒副作用的發(fā)生均有一定的劑量依賴性。
[Abstract]:Objective to summarize the toxic and side effects of high dose methotrexate HDMTX in order to provide a theoretical basis for optimizing the treatment of HDMTX. Methods the clinical data of 601 children with acute lymphoblastic leukemia or non-Hodgkin 's lymphoma treated with HDMTX were retrospectively analyzed. According to the WHO criteria for the classification of toxicity and side effects of anticancer drugs, the toxicity and side effects of each system were analyzed. Results Bone marrow suppression appeared in almost all children after HDMTX treatment. The most common toxic side effects of alanine aminotransferase are alanine aminotransferase (alanine aminotransferase) 60.4m; urinary system is the most common side effect is proteinuria 9.2G; the highest incidence of skin symptoms is the skin erythema 7.2B; nervous system toxicity. Side effects such as hyperalgesia, Severe side effects of HDMTX were observed only in the blood system and digestive system in 7 patients with limb numbness or headache. Compared with the MTX3 gr / m 2 group, the 24 h MTX concentration in the 5 g / m 2 HDMTX group was higher than that in the 5 g / m 2 HDMTX group (P 0.05), hemoglobin and platelet reduction, oral mucositis, hemoglobin and thrombocytopenia, and oral mucositis. The incidence of toxic side effects such as proteinuria and skin symptoms is also higher than that of P0.050.Conclusion the severe side effects after HDMTX treatment are mainly in the blood system and digestive system, bone marrow suppression, oral mucositis, proteinuria, etc. The occurrence of toxic side effects such as skin symptoms was dose dependent.
【作者單位】： 北京大學(xué)第一醫(yī)院兒科;
【分類號(hào)】：R733

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本文編號(hào)：1631070