摘要： 目的 探讨进一步降低大剂量氨甲蝶呤(HD-MTX)治疗小儿急性淋巴细胞白血病(ALL)毒副反应的方法。方法 对2000年1月至2001年12月在上海儿童医学中心血液肿瘤科住院治疗的47例ALL患儿共进行的134例次HD-MTX治疗，按照两种不同的水化、碱化方法，分为全国标准治疗组和观察组。观察患儿血清中的MTX浓度、治疗效果及毒副反应的发生率。结果 (1)按WHO相关分度标准，各种毒副反应的发生率、Ⅲ度或Ⅲ度以上的毒副作用者的发生率两组比较差异有显著性意义。(2)观察组有2例次出现尿素氮的升高，标准治疗组未出现。(3)在应用HD-MTX开始后44h、68h时血清MTX浓度异常者两组相比较差异有显著性意义。结论 观察组HD-MTX的毒副反应发生率及严重程度均明显低于全国标准治疗组，且减少治疗费用,而不影响HD-MTX治疗效果。
Abstract Objective To study the ways to further reduce the toxic sideeffects of the HD-MTX in the treatment of childhood acute lymphoblastic leukemia.
Methods The patients were divided into two groups:the testing and the treatment group.Two different ways of hydration and alkalization were used in the course of HD-MTX to evaluate the treatment results.Monitor the dynamic changes of the serum MTX level and occurrence of the toxic sideeffects.
Results The results showed:(1)comparing the above toxic sideeffects occurred in both groups,significant difference could be found;(2)blood urea nitrogen(BUN) increased in 2 cases in the testing group but no one happened in the treatment group;(3)the occurrence of the serum MTX level abnormalities after 44 and 68 hours of HD-MTX treatment appeared in both groups with significant difference.
Conclusion It shows the protocol for hydration and alkalization in the testing group has greater advantage than that in the treatment group in reducing the toxic sideeffects.This may decrease the cost of treatment,but may not influence the treatment effect of HD-MTX.
Key words Methotrexate;Leukemia;Lymphoblastic;AcuteSideeffect
刘安生,高英,薛惠良,王耀平. 大剂量氨甲蝶呤治疗小儿急性淋巴细胞白血病水化和碱化方法的探讨[J]. 中国实用儿科杂志.
Liu Ansheng,Xue Huiliang,Wang Yaoping.. Comparative study on two different ways of hydration and alkalization in the treatment of childhood acute lymphoblastic leukemia with highdose methotrexate.[J]. .
