论文部分内容阅读
目的探讨大剂量甲氨蝶呤(HD-MTX)化疗后药物不良反应的影响因素,为实现甲氨蝶呤个体化用药提供依据。方法收集2014年6月至2016年12月新疆医科大学第一附属医院血液病中心及儿科中心147例淋巴系统恶性肿瘤患者的临床病例,记录患者用HD-MTX化疗前后的相关信息,用单因素法分析患者使用HD-MTX化疗后药物不良反应的影响因素。结果影响药物不良反应的因素包括民族、年龄、联合化疗、疗程数、化疗前血小板(PLT)、化疗前谷丙转氨酶(ALT)、化疗前谷草转氨酶(AST)、体重指数(BMI)、体表面积和甲氨蝶呤给药剂量(P<0.05)。骨髓抑制发生情况:化疗前PLT异常的患者高于化疗前PLT正常的患者,体表面积大的患者高于体表面积小的患者;肝功能损伤发生情况:儿童患者高于成人患者,单用HD-MTX化疗患者高于联合化疗患者,化疗3次以上的患者高于化疗2次以下的患者,化疗前肝功能异常患者高于化疗前肝功能正常患者,体表面积小的患者高于体表面积大的患者,甲氨蝶呤给药剂量大的患者高于甲氨蝶呤给药剂量小的患者;急性肾损伤发生情况:汉族患者高于维吾尔族患者,成人患者高于儿童患者,BMI大的患者高于BMI小的患者,体表面积大的患者高于体表面积小的患者。结论临床使用HD-MTX时,应对患者的民族、年龄、体表面积、BMI、联合化疗、疗程数、给药剂量、化疗前肝功能和血常规等影响因素多加关注,以降低药物不良反应的发生率。
Objective To investigate the influencing factors of adverse drug reactions after high-dose methotrexate (HD-MTX) chemotherapy and provide basis for individualized use of methotrexate. Methods The clinical data of 147 patients with lymphatic system malignant tumor from Department of Hematology and Pediatrics, the First Affiliated Hospital of Xinjiang Medical University from June 2014 to December 2016 were collected. The patients’ information before and after HD-MTX chemotherapy was recorded. Method to analyze the influencing factors of ADR after HD-MTX chemotherapy in patients. Results The factors influencing adverse drug reactions included ethnicity, age, combination chemotherapy, number of courses of treatment, PLT before chemotherapy, ALT, AST, BMI, body surface area And methotrexate (P <0.05). The incidence of myelosuppression: patients with abnormal PLT before chemotherapy were higher than patients with normal PLT before chemotherapy, patients with large body surface area were higher than those with small body surface area. The incidence of liver injury was higher in children than in adults, The patients with MTX chemotherapy were higher than those with combination chemotherapy, the patients with chemotherapy more than 3 times were higher than those with chemotherapy less than 2 times, the patients with abnormal liver function before chemotherapy were higher than the patients with normal liver function before chemotherapy, the patients with small body surface area were higher than those with large body surface area Patients with high doses of methotrexate were treated with a lower dose of methotrexate than those with methotrexate. The incidence of acute kidney injury was higher in Han patients than in Uyghur patients, in adult patients than in children, and in patients with large BMI Patients with a higher body surface area than those with a low BMI have a higher body surface area. Conclusions When HD-MTX is used clinically, attention should be paid to factors such as ethnicity, age, body surface area, BMI, combination chemotherapy, number of courses of treatment, dosage of administration, liver function and blood routine before chemotherapy to reduce adverse drug reactions rate.