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探讨大剂量氨甲喋呤（HDMTX）治疗急性淋巴细胞性白血病（ALL）的临床指征，观察治疗的副作用及对周围血象和肝、肾功能的影响。方法详细观察和记录15例病人45例次治疗时的耐受情况及出现的副作用，动态观察周围血象及肝、肾功能变化。结果全部病人均能耐受治疗。副作用以食欲低下最常见（36／45），其他依次为呕吐（13／45），低热（8／45），头痛（6／45），腹泻（4／45），口腔溃疡（3／45），皮疹（1／45）。对周围血象主要引起白细胞下降，对红细胞、血小板影响较小。部分病例（9／45）用药过程中出现一过性丙氨酸转氨酶（ALT）升高，但均能恢复正常。对血尿素氮（BUN）、肌酐（Cr）无影响。结论ALL病儿在骨髓达完全缓解标准后，肝、肾功能正常，血红蛋白＞80g／L，血小板＞80×109／L，白细胞首次用药＞3．0×109／L，2、3次用药＞2．0×109／L，即能耐受治疗。治疗前后对病儿进行碱化水化处理可明显减轻HDMTX治疗的副作用。
To investigate the clinical indications of high-dose methotrexate (HDMTX) in the treatment of acute lymphoblastic leukemia (ALL), observe the side effects of treatment and the influence on peripheral blood and liver and kidney function. Methods To observe and record the tolerability and side effects of 45 cases of 15 patients at the time of secondary treatment. Dynamic observation of peripheral blood and changes of liver and kidney function were performed. Results All patients were able to tolerate treatment. The most common side effects were low appetite (36/45), followed by vomiting (13/45), fever (8/45), headache (6/45), diarrhea (4/45), mouth ulcers (3/45) Rashes (1/45). The peripheral blood is mainly responsible for the decline of white blood cells and has little effect on red blood cells and platelets. A transient alanine aminotransferase (ALT) elevation occurred in some cases (9/45) but they both returned to normal. No effect on blood urea nitrogen (BUN) and creatinine (Cr). Conclusion After complete remission of bone marrow in children with ALL, liver and kidney function were normal, hemoglobin was >80g/L, platelets were >80×109/L, and leukocytes were used for the first time> 3.0×109/L, and 2 and 3 doses> 2.0 × 109 / L, that can tolerate treatment. Alkaline hydration treatment of sick children before and after treatment can significantly reduce the side effects of HDMTX treatment.