[大剂量甲氨蝶呤与脑神经毒性。关于一例蛛网膜炎病例]
[High-dose methotrexate and cerebral neurotoxicity. Apropos of a case of arachnoiditis].
作者信息
Brain E, Alexandre J, Minozzi C, Misset J L
机构信息
Département d'Oncologie médicale, Centre Georges-François Lederc, Dijon.
出版信息
Presse Med. 1997 Mar 1;26(6):265-8.
BACKGROUND
High-dose methotrexate has been used as a therapeutic strategy in osteosarcoma for 20 years. Cerebral neurotoxicity is frequent.
CASE REPORT
A 21-year-old patient with non-metastatic osteosarcoma was given high-dose methotrexate prior to surgery. He developed subacute encephalitis and arachnoiditis after intravenous injection of methotrexate.
COMMENTS
Although pharmacokinetic monitoring and leucovorin rescue is helpful in controlling systemic toxicity, cerebral toxicity with acute, subacute or delayed reactions may occur, depending on the administration route and use of the folate antagonist. Generally, acute arachnoiditis and subacute encephalitis are reversible and occur respectively after intrathecal methotrexate and intravenous high-dose methotrexate, while the chronic delayed leukoencephalopathy usually begins several months after a combination regime using intrathecal methotrexate, intravenous methotrexate and cerebral irradiation.
背景
大剂量甲氨蝶呤作为骨肉瘤的一种治疗策略已应用20年。脑神经毒性很常见。
病例报告
一名21岁的非转移性骨肉瘤患者在手术前接受了大剂量甲氨蝶呤治疗。他在静脉注射甲氨蝶呤后出现了亚急性脑炎和蛛网膜炎。
评论
尽管药代动力学监测和亚叶酸钙解救有助于控制全身毒性，但根据给药途径和叶酸拮抗剂的使用情况，可能会发生伴有急性、亚急性或延迟反应的脑毒性。一般来说，急性蛛网膜炎和亚急性脑炎是可逆的，分别发生在鞘内注射甲氨蝶呤和静脉注射大剂量甲氨蝶呤后，而慢性延迟性白质脑病通常在联合使用鞘内注射甲氨蝶呤、静脉注射甲氨蝶呤和脑部放疗几个月后开始出现。
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