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目的 :探讨不同四氢叶酸解救方法对大剂量甲氨喋呤 (HDMTX)的毒性作用和疗效的影响。方法 :对 15例 80次 HDMTX治疗应用 2种不同四氢叶酸解救方法 ,每次 15 m g/ m2于 12 h开始和每次 12 mg/ m2于 2 4h开始 ,观察毒副作用和疗效 ,应用荧光偏振免疫分析法测定血清 MTX浓度。结果 :试验组 4例 HDMTX静滴结束后 2 4h和 48h的血清药物浓度均未达到毒性浓度。2种四氢叶酸解救方法的毒副作用发生率和恢复时间无明显差异。2组在随访期内的脑膜白血病复发率分别为 1/ 6和 0 / 9。结论 :应用 HDMTX(3.0 g/ m2 )持续 2 4h静滴时 ,推迟四氢叶酸解救的开始时间和减少四氢叶酸总量不增加毒性作用的发生率和严重程度 ,且有利于提高疗效。
Objective: To investigate the effects of different tetrahydrofolate rescue methods on the toxic effects and therapeutic effects of high-dose methotrexate (HDMTX). Methods: Fifteen 80 HDMTXs were treated with two different solutions of tetrahydrofolate. Each time, 15 mg / m2 started at 12 h and each 12 mg / m2 started at 24 h. The side effects and therapeutic effects were observed. Fluorescence polarization Serum MTX concentration was determined by immunoassay. Results: The serum concentration of HDMTX in the experimental group did not reach the toxic levels at 24 h and 48 h after the end of intravenous drip. There was no significant difference in the incidence of side effects and recovery time between the two methods of rescue of tetrahydrofolate. The recurrence rates of meningococcal leukemia in the two groups during follow-up were 1/6 and 0/9, respectively. CONCLUSIONS: When HDMTX (3.0 g / m 2) is administered intravenously for 24 h, the delay in the onset of tetrahydrofolate rescue and the reduction in total tetrahydrofolate do not increase the incidence and severity of toxic effects and are beneficial for improving efficacy.