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目的:分析鞘内注射甲氨蝶呤引起患者脊髓病变的风险因素。方法:检索1969年至2007年有关国外鞘内注射甲氨蝶呤文献,引起患者脊髓病变共36例,对患者的年龄、原发病、鞘内注射剂量及注射次数,联合用药、发生脊髓病变情况及转归进行统计分析。结果:患者年龄<18岁30例(83.3%);34例注明甲氨蝶呤单次剂量,其中≤15mg者28例(77.8%),其他均<50mg;鞘内注射>5次者27例;截瘫发生第1次鞘内注射者仅2例。甲氨蝶呤单独应用11例,同阿糖胞苷及/或激素联合注射者25例;11例脊髓病变发生时间为鞘内注射后24h内,35例表现为双下肢或四肢弛缓性瘫痪,经大剂量甲泼尼龙及叶酸治疗,其中21例(58.3%)肢体运动及感觉功能完全或部分恢复,11例死亡(30.6%)。结论:甲氨蝶呤鞘内注射致脊髓病变可能和甲氨蝶呤注射次数较频、剂量较大以及多药联用有关。
OBJECTIVE: To analyze the risk factors of spinal cord injury caused by intrathecal methotrexate. Methods: The literature about intrathecal methotrexate intrathecally injected from 1969 to 2007 was retrieved. Thirty-six cases of myelopathy were recorded. The age, primary disease, intrathecal injection and times of injection, combination therapy and myelopathy Situation and outcome of statistical analysis. RESULTS: Thirty patients (83.3%) were under 18 years of age, 34 were given a single dose of methotrexate, of whom 28 (77.8%) were less than or equal to 15 mg, and all others were less than 50 mg and intrathecally injected more than 5 times Cases; paraplegia first intrathecal injection in only 2 cases. Eleven cases of methotrexate alone, with cytarabine and / or hormone injection in 25 cases; 11 cases of spinal cord lesions within 24h after intrathecal injection, 35 cases showed flaccid paralysis of both lower extremities or limbs, After high-dose methylprednisolone and folic acid treatment, 21 cases (58.3%) recovered limb movement and sensory function completely or partially, and 11 died (30.6%). Conclusion: Intrathecal injection of methotrexate caused spinal cord lesions may be related to the frequency of methotrexate injection, the larger dose and multi-drug combination.