Haselberger M B, Schwinghammer T L
Veterans Affairs Medical Center, Cleveland, OH, USA.
Ann Pharmacother. 1995 Sep;29(9):918-21. doi: 10.1177/106002809502900914.
For these reasons, a definitive statement about the relative efficacy of mesna for prophylaxis of cyclophosphamide-associated HC in BMT patients cannot be made. Because HC is a frequent and potentially serious complication of high-dose cyclophosphamide therapy, the implementation of some preventive measure is mandatory in all patients. Unless medically contraindicated, provision of sufficient hydration and diuresis to maintain adequate high urine flow should be a component of all prophylactic regimens. It is unclear whether the addition of mesna therapy or bladder irrigation to intravenous hydration provides greater protection. Studies indicate that mesna probably has no adverse effect on engraftment. This is consistent with its chemistry and pharmacology, as the drug is hydrophilic and activated only in the kidneys. Thus, it is inactive in the bloodstream and unable to penetrate cell membranes and interfere with the action of cyclophosphamide. Although safety issues surrounding the use of mesna for prevention of cyclophosphamide-associated HC appear to have been resolved, efficacy issues must await the completion of further well-controlled comparative trials.
基于这些原因，关于美司钠在预防骨髓移植患者环磷酰胺相关出血性膀胱炎方面的相对疗效，目前还无法给出确切的定论。由于出血性膀胱炎是高剂量环磷酰胺治疗常见且可能严重的并发症，因此对所有患者实施一些预防措施是必要的。除非有医学禁忌，保证充足的水化和利尿以维持足够高的尿量应是所有预防方案的组成部分。尚不清楚在静脉水化基础上加用美司钠治疗或膀胱冲洗是否能提供更好的保护。研究表明美司钠可能对植入没有不良影响。这与其化学性质和药理学特性相符，因为该药物具有亲水性，仅在肾脏中被激活。因此，它在血液中无活性，无法穿透细胞膜并干扰环磷酰胺的作用。虽然围绕使用美司钠预防环磷酰胺相关出血性膀胱炎的安全性问题似乎已得到解决，但疗效问题仍有待进一步完善的对照比较试验完成后才能确定。
