[大剂量甲氨蝶呤治疗期间的血药浓度监测]
[Blood concentration monitoring during high-dose methotrexate treatment].
作者信息
Jiao Li, Zhou Dao-Bin, Wang Shu-Jie, Zhang Wei, Duan Ming-Hui, Li Jian, Han Bing, Xu Ying, Zhao Yong-Qiang, Shen Ti, Wang Qiang, Ye Min
机构信息
Department of Hematology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
出版信息
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2009 Oct;31(5):564-6.
OBJECTIVE
To explore the clinical value of blood concentration monitoring during high-dose methotrexate (MTX) treatment.
METHODS
High-dose MTX (1.5-9.0 g) was infused to 105 patients with acute lymphoblastic leukemia or lymphoma, and then the blood MTX concentration was measured by fluorescence polarization immune assay (FPIA) 44 hours after the start of administration. The procedure was repeated every 6-12 hours until the concentration was less than 0.1 micromol/L.
RESULTS
Forty-four hours after the start of administration, the blood MTX concentration (C(MTX/44h)) was > or = 5 micromol/L in 6 patients (2.8%) and was between 1 and 5 micromol/L in 23 patients (10.6%). C(MTX/44h) > or = 1 micromol/L was more common in patients received 5.0 g MTX. No severe adverse event was observed in all patients.
CONCLUSIONS
Blood MTX concentration is different after high-dose MTX treatment due to individual metabolic differences, and therefore it is clinically important to monitor blood concentration of MTX. Elimination delay is more common in patients receive 5.0 g MTX. Application of high-dose MTX therapy under the monitoring of blood MTX concentration is safe and feasible.
目的
探讨大剂量甲氨蝶呤（MTX）治疗期间血药浓度监测的临床价值。
方法
对105例急性淋巴细胞白血病或淋巴瘤患者输注大剂量MTX（1.5 - 9.0 g），给药开始44小时后采用荧光偏振免疫分析法（FPIA）测定血MTX浓度。每6 - 12小时重复该操作，直至浓度低于0.1微摩尔/升。
结果
给药开始44小时后，6例患者（2.8%）血MTX浓度（C(MTX/44h)）≥5微摩尔/升，23例患者（10.6%）血MTX浓度在1至5微摩尔/升之间。接受5.0 g MTX治疗的患者中C(MTX/44h)≥1微摩尔/升更为常见。所有患者均未观察到严重不良事件。
结论
由于个体代谢差异，大剂量MTX治疗后血MTX浓度存在差异，因此监测MTX血药浓度具有重要临床意义。接受5.0 g MTX治疗的患者中消除延迟更为常见。在血MTX浓度监测下应用大剂量MTX治疗是安全可行的。
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