Mahadeo Kris M, Dhall Girish, Panigrahy Ashok, Lastra Carlos, Ettinger Lawrence J
Division of Pediatric Hematology-Oncology, Children's Hospital at Montefiore, Bronx, New York 10467, USA.
Pediatr Hematol Oncol. 2010 Feb;27(1):46-52. doi: 10.3109/08880010903341904.
From as early as the 1970s methotrexate has been associated with disseminated necrotizing leukoencephalopathy and other neurotoxic sequelae. Yet, a clear mechanism for methotrexate-induced neurotoxicity has not been established. The authors describe the case of a 12-year-old male with acute lymphoblastic leukemia and a homozygous methylenetetrahydrofolate reductase C677T mutation, who developed subacute methotrexate-induced toxicity and cerebral venous thrombosis after receiving intrathecal methotrexate. The role of homocysteine as a possible mediator in methotrexate-induced neurotoxicity via direct endothelial injury is discussed.
早在20世纪70年代，甲氨蝶呤就与播散性坏死性白质脑病及其他神经毒性后遗症相关。然而，甲氨蝶呤诱导神经毒性的明确机制尚未确立。作者描述了一名12岁患急性淋巴细胞白血病且携带纯合亚甲基四氢叶酸还原酶C677T突变的男性病例，该患者在接受鞘内注射甲氨蝶呤后出现亚急性甲氨蝶呤诱导的毒性反应及脑静脉血栓形成。文中讨论了同型半胱氨酸作为通过直接内皮损伤介导甲氨蝶呤诱导神经毒性的一种可能介质的作用。
