Gibson T P, Reich S D, Krumlovsky F A, Ivanovich P, Gonczy C
Clin Pharmacol Ther. 1978 Mar;23(3):351-5. doi: 10.1002/cpt1978233351.
Removal of methotrexate by Amberlite XAD-4 hemoperfusion was determined in a patient with metastatic breast carcinoma. During 4 hr of hemoperfusion the plasma concentration of methotrexate fell from 5.5 x 10(-7) M TO 3.1 x 10(-7) M. After hemoperfusion methotrexate concentration increased as a consequence of multicompartmental pharmacokinetics to 5.5 x 10(-7) M and then slowly declined. Plasma methotrexate clearance decreased from 79 ml/min 30 min into hemoperfusion to 28 ml/min at the conclusion. In vitro clearance of methotrexate by 17 artificial kidneys, Amberlite XAD-4, and uncoated charcoal was determined. Uncoated charcoal had the greatest clearance of methotrexate of all the devices tested. We conclude that: (1) Amberlite XAD-4 transiently reduces plasma methotrexate concentration; (2) in vitro, charcoal hemoperfusion is more effective than XAD-4 in removing methotrexate; (3) as a consequence of the multicompartmental pharmacokinetics of methotrexate a postperfusion rebound in plasma methotrexate concentration is to be expected.
在一名转移性乳腺癌患者中测定了通过Amberlite XAD - 4血液灌流清除甲氨蝶呤的情况。在4小时的血液灌流过程中，甲氨蝶呤的血浆浓度从5.5×10⁻⁷M降至3.1×10⁻⁷M。血液灌流后，由于多室药代动力学，甲氨蝶呤浓度升高至5.5×10⁻⁷M，然后缓慢下降。血液灌流30分钟时血浆甲氨蝶呤清除率从79毫升/分钟降至结束时的28毫升/分钟。测定了17个人工肾、Amberlite XAD - 4和未包被活性炭对甲氨蝶呤的体外清除率。在所有测试装置中，未包被活性炭对甲氨蝶呤的清除率最高。我们得出以下结论：（1）Amberlite XAD - 4可短暂降低血浆甲氨蝶呤浓度；（2）在体外，活性炭血液灌流在清除甲氨蝶呤方面比XAD - 4更有效；（3）由于甲氨蝶呤的多室药代动力学，预计血液灌流后血浆甲氨蝶呤浓度会出现反跳。
