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目的:研究监测甲氨蝶呤血药浓度对大剂量甲氨蝶呤加亚叶酸钙方案治疗儿童急性淋巴细胞白血病的作用。方法:收集进行甲氨蝶呤血药浓度监测前后使用大剂量甲氨蝶呤加亚叶酸钙化疗的急性淋巴细胞白血病儿童的病例,对用药特点、给药方式和出现的不良反应进行统计分析和临床安全性评价。结果:开展血药浓度监测前病例所出现的不良反应发生率为75.1%,与开展血药浓度监测后的病例出现的不良反应发生率79.6%相比,差异无显著性;但开展血药浓度监测后病例出现的不良反应比监测前的明显减轻,严重不良反应发生率为21.95%,与之前的严重不良反应发生率36.51%相比,差异有显著性。结论:大剂量甲氨蝶呤加亚叶酸钙治疗儿童急性淋巴细胞白血病时,会出现化疗过程中的各种不良反应;但进行甲氨蝶呤血药浓度监测能及时有效的进行亚叶酸钙解救,可减少和预防甲氨蝶呤严重不良反应的出现。
Objective: To study the effect of monitoring methotrexate plasma concentration on high dose methotrexate plus leucovorin regimen in children with acute lymphoblastic leukemia. Methods: The cases of children with acute lymphoblastic leukemia treated with high dose methotrexate and calcium leucovorin before and after methotrexate plasma concentration monitoring were collected, and the characteristics of medication, mode of administration and adverse reactions were statistically analyzed and Clinical safety assessment. Results: The incidence of adverse reactions was 75.1% before the monitoring of blood concentration was conducted. There was no significant difference between the two groups in the incidence of adverse reactions after the monitoring of blood concentration was 79.6%. However, After the monitoring, the adverse reactions in the cases were obviously relieved than those before the monitoring. The incidence of serious adverse reactions was 21.95%, which was significantly different from the incidence of serious adverse reactions before 36.51%. CONCLUSIONS: High doses of methotrexate and leucovorin are used to treat various kinds of adverse reactions during chemotherapy in children with acute lymphoblastic leukemia. However, methotrexate plasma concentration monitoring can effectively and timely rescue leucovorin , Can reduce and prevent the emergence of serious adverse reactions of methotrexate.