摘要
目的研究四氢叶酸钙(CF)对急性淋巴细胞白血病(ALL)患儿大剂量甲氨蝶呤(HD-MTX)治疗的血药浓度及不良反应的影响。方法将我院2014年1月-2015年12月收治的80例ALL患儿按治疗方案分成观察组和对照组(每组40例),观察组HD-MTX静脉滴注24 h后,在12 h后予以CF解救,对照组HD-MTX静脉滴注6 h后,在30 h后予以CF解救,采用荧光偏振免疫分析测检甲氨蝶呤给药后在24 h、48 h后的血药浓度及不良反应。结果两组患儿解救24 h后,观察组血药浓度>1.00μmo/L者所占比例(20.00%)明显低于对照组(42.50%),到达安全血药浓度(<0.15μmo/L)者所占比例(25.00%)明显优于对照组(5.00%),差异有统计学意义(P<0.05);观察组血药浓度值在0.15~1μmo/L之间者所占比例(55.00%)与对照组(52.50%)比较,差异无统计学意义(P>0.05);两组患儿解救48 h后上述指标比较差异均无统计学意义(P>0.05)。解救期间两组患者均出现不良反应,其中观察组在黏膜损伤、消化道损伤、骨髓抑制中所占比例明显低于对照组,差异有统计学意义(P<0.05);观察组肝功能和肾功能损害所占比例与对照组比较差异无统计学意义(P>0.05)。结论不同时间予以CF解救HD-MTX治疗带来的不良反应和降低血药浓度,虽然均能解毒,但24 h静脉滴注MTX后,第12 h予以解毒,解救疗效更好,安全性更高。
Objective To investigate the effect of calcium folinate（CF） on blood concentrations and adverse reactions of patients with acute lymphoblastic leukemia（ALL）. Methods Eight cases of ALL treated in our hospital between January 2014 and December 2015 were selected and divided into the observation group and control group （40 cases in each group）. After 24 h HD -MTX,the control group was given CF after 12 h. After 6 h HD-MTX,the control group was given CF after 30 h. FPIA was used to detect blood concentrations and adverse reactions after 24h and 48h. Results After rescue of 24 h,the number of patients with blood concentrations above 1.00 μmol/L accounted for 20. 00% of the observation group, obviously smaller than that of the control group （42. 50% ）, but patients with blood concentrations below 0. 15 μmol/L accounted for 25.00%, which obviously outnum- bered that of the control group （5.00%）, and the difference was statistically significant （P〈0. 05 ）. Cases with blood concentra- tions ranging from 0. 15 to 1μmol/L accounted for 55. 00% of the observation group, compared with 52. 50% in the control group ; the difference was not statistically significant （P〉0.05）. After rescue of 48 h, the difference in the above indicators be- tween the observation group and the control group was not statistically significant （P〉0. 05）. During rescue, side effects occurred in all the patients. The proportion of mucous injuries, alimentary injuries, and myelosuppression in the observation group was obvi- ously lower than that of the control group, and the difference was statistically significant （ P〈0. 05）. The proportion of liver func- tion and renal function damage was lower in the observation group than in the control group, and the difference was not statistically significant （ P〉0. 05 ）. Conclusion Application of CF in rescuing patients with acute lymphoblastic leukemia treated by HD-MTX at different times points has different effect. After HD-MTX of 24 h,the use of CF for rescue after 12 h has better effect.
出处
《解放军预防医学杂志》
CAS
2017年第6期604-606,610,共4页
Journal of Preventive Medicine of Chinese People's Liberation Army
基金
山东省中医药科技发展计划项目(No.2013-200)
