骨肉瘤儿童多次大剂量甲氨蝶呤化疗后出现严重消除延迟病例分析

摘要/Abstract

摘要： 目的：探讨多次大剂量甲氨蝶呤（HD-MTX）化疗后出现排泄延迟的影响因素，旨在促进临床合理用药。方法：我院1例骨肉瘤患儿在多次进行 HD-MTX 化疗过程中出现 MTX 排泄异常。查阅医院电子病例系统，收集患儿各项诊疗、检查及用药资料对可能引起 MTX 排泄异常的相关因素进行分析。结果：该病例患儿在进行 HD-MTX 化疗过程中出现严重消除延迟可能与患儿的合并用药、多周期化疗等因素有关，与个体遗传基因、亚叶酸钙(CF)、MTX剂量及解救方案、尿液pH等因素可能无关。结论：同一患者在不同轮次HD-MTX化疗时，清除率有很大波动，因此每一次的化疗都应该密切关注，化疗前预处理，治疗过程中做好水化碱化、CF解救，定期监测MTX血药浓度，可减少不良反应事件的发生，同时提高疗效。

关键词: font-size:medium, ">骨肉瘤；大剂量甲氨蝶呤；儿童；排泄延迟；治疗药物监测

Abstract: Objective：To explore the influencing factors of delayed excretion after multiple high-dose methotrexate (HD-MTX) chemotherapy， so as to promote rational clinical medication. Methods：A child with osteosarcoma had abnormal MTX excretion during multiple HD-MTX chemotherapy in our hospital. By consulting the hospital electronic medical record system， collecting the diagnosis， treatment， examination and medication information of the related factors that may cause MTX excretion abnormalities were analyzed.Results：The delayed elimination in the course of HD-MTX patients chemotherapy may be related to the combined medication and multicycle chemotherapy. It may not be related to individual genetic factors， CF， MTX dose and rescue regimen， and urine pH.Conclusion： The clearance rate of the same patient fluctuated greatly in different rounds of HD-MTX chemotherapy. Therefore， close attention should be paid to each round of chemotherapy，pre-treatment before chemotherapy， hydration and alkalization， calcium folinate rescue， regular monitoring of MTX blood concentration， so as to reduce the occurrence of adverse events and improve the treatment efficacy.

Key words: font-size:medium, ">Osteosarcoma； High-dose methotrexate； Children； Elimination delay； Therapeutic drug monitoring

中图分类号:

赵海艳, 于芝颖, 黄琳. 骨肉瘤儿童多次大剂量甲氨蝶呤化疗后出现严重消除延迟病例分析[J]. 中国医药导刊, 2023, 25(4): 444-446.

ZHAO Haiyan, YU Zhiying, HUANG Lin. Analysis of Severe Delayed Elimination after Multiple High-Dose Methotrexate Chemotherapy in a Child with Osteosarcoma[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2023, 25(4): 444-446.

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