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目的研究急性淋巴细胞白血病(ALL)患儿接受大剂量甲氨蝶呤(MTX)化疗后发生白细胞减少的相关影响因素。方法回顾性分析183例ALL患儿的临床资料,用Logistic回归分析ALL患儿的性别、年龄、MTX剂量、化疗开始后第24,42 h的MTX血清浓度(C24和C42)与化疗后白细胞减少发生率的相关性。结果在540例次大剂量MTX化疗中,263例次化疗后发生白细胞减少,白细胞减少的发生率为48.70%。多因素Logistic回归分析显示,年龄(P<0.01)和C24(P<0.01)与化疗后白细胞减少的发生显著相关,其回归系数分别为-0.064和0.025。结论 C24与白细胞减少发生率显著正相关,加强甲氨蝶呤血清浓度监测与甲酰四氢叶酸钙解救,有助于降低白细胞减少的发生率。
Objective To study the related factors of leukopenia in children with acute lymphoblastic leukemia (ALL) receiving high dose methotrexate (MTX) chemotherapy. Methods The clinical data of 183 ALL children were retrospectively analyzed. Logistic regression analysis was used to analyze the gender, age, MTX dose, the serum levels of MTX (C24 and C42) at 24 and 42 h after chemotherapy and the leukopenia The incidence of the correlation. Results In 540 high-dose MTX chemotherapy, leukopenia occurred after 263 chemotherapy cycles and the incidence of leukopenia was 48.70%. Multivariate Logistic regression analysis showed that age (P <0.01) and C24 (P <0.01) were significantly associated with leukopenia after chemotherapy, with regression coefficients of -0.064 and 0.025, respectively. Conclusions There is a significant positive correlation between C24 and the incidence of leukopenia. Enhancing the monitoring of methotrexate serum concentration and levofloxacin rescue may help to reduce the incidence of leukopenia.