【摘要】 目的 :研究应用大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的不良反应。方法 :选取2015年02月—2018年02月我院收治的急性淋巴细胞白血病患儿90例,按随机数字表法分成两组,各45例,两组均采用常规诱导治疗,在各项指标均良好的状态下,对照组给予小剂量甲氨蝶呤(44 h浓度≤1.0μmol/L)治疗,观察组给予大剂量甲氨蝶呤(44 h浓度> 1.0μmol/L)治疗,比较两组疗效及不良反应发生情况。结果 :观察组治疗有效率显著高于对照组,差异有统计学意义(P <0.05);两组均出现感染、胃肠道反应、肝功能损害、骨髓抑制等不良反应,差异无统计学意义(P> 0.05);观察组治疗后皮肤黏膜损害、神经损害、心肌酶谱异常、心电图异常评分均高于对照组,差异有统计学意义(P <0.05)。结论 :大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的疗效显著,但对皮肤黏膜、神经系统及心脏的损害显著,治疗时应加强对甲氨蝶呤血药浓度的监测,并根据个体差异制定最佳方案。更多还原

【Abstract】 Objective: To study the adverse reactions of high-dose methotrexate in the treatment of childhood acute lymphoblastic leukemia. Methods: 90 children with acute lymphoblastic leukemia admitted to our hospital from February 2015 to February 2018 were selected and randomly divided into two groups, 45 children in each group. The children in the two groups were given conventional induction treatment. When various indexes were all good, the children in the control group were given a small dose of methotrexate (44 h concentration ≤ 1.0 μmol/L), and the children in the observation group were given a high dose of methotrexate (44 h concentration>1.0 μmol/L). The efficacy and adverse reactions were compared between the two groups. Results: The effective rate in the observation group was significantly higher than that in the control group (P<0.05). There were infections, gastrointestinal reactions, liver damage, bone marrow suppression and other adverse reactions in the two groups, but the differences were not statistically significant (P>0.05). The skin mucosal damage, nerve damage, myocardial zymogram abnormality and electrocardiogram abnormality scores in the observation group were significantly higher than those in the control group (P<0.05). Conclusion: The high-dose methotrexate is effective in the treatment of childhood acute lymphoblastic leukemia, but the damage to skin mucosa and nervous system and heart is significant. The monitoring of methotrexate blood concentration should be strengthened during treatment, and the best solution should be developed based on individual differences.更多还原