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目的探讨大剂量甲氨蝶呤(MTX)治疗儿童急性淋巴细胞白血病的临床效果。方法选取2011年1月至2013年12月间收治的急性淋巴细胞白血病患儿96例,采用随机数字表法分为对照组和治疗组,每组48例,对照组患者采用VDLP方案[长春新碱(VCR)、柔红霉素(DXR)、左旋门冬酰胺酶(L-ASP)、泼尼松(Pre)]进行治疗,治疗组患者采用大剂量MTX治疗,观察两组患儿治疗后的疗效、安全性,并对治疗组患儿血浆MTX的血药浓度进行监测。结果治疗组完全缓解率和总有效率分别为66.7%(32/48)和89.6%(43/48),显著高于对照组的37.5%(18/48)和70.8%(34/48),差异有统计学意义(P<0.05);治疗组患者不良反应发生率为20.8%,对照组患者不良反应发生率为35.4%,差异有统计学意义(P<0.05);治疗组患儿48 h血浆MTX浓度<0.25μmol/L者39例,占81.3%;患儿48 h血浆MTX浓度≥1μmol/L者3例,占6.3%。结论大剂量MTX治疗儿童急性淋巴细胞白血病临床效果显著,在血浆MTX浓度监测下,实施个体化甲酰四氢叶酸钙解救,毒副反应轻微,值得临床推广。
Objective To investigate the clinical effect of high-dose methotrexate (MTX) in the treatment of childhood acute lymphoblastic leukemia. Methods Ninety-six children with acute lymphoblastic leukemia who were admitted from January 2011 to December 2013 were randomly divided into control group and treatment group, with 48 cases in each group. The control group received VDLP regimen [Changchun Xin (VCR), daunorubicin (DXR), L-asparaginase (L-ASP) and prednisone. The patients in the treatment group were treated with high-dose MTX. After treatment, Efficacy and safety, and monitoring plasma concentrations of MTX in the treatment group. Results The complete remission rate and total effective rate were 66.7% (32/48) and 89.6% (43/48) in the treatment group, which were significantly higher than those in the control group (37.5%, 18/48) and 70.8% (34/48) The difference was statistically significant (P <0.05). The incidence of adverse reactions in the treatment group was 20.8%, while that in the control group was 35.4%, the difference was statistically significant (P <0.05). In the treatment group, the incidence of adverse reactions was 48.8 Plasma MTX concentration of <0.25μmol / L in 39 cases, accounting for 81.3%; children 48h plasma MTX concentration ≥ 1μmol / L in 3 cases, accounting for 6.3%. Conclusion High-dose MTX treatment of children with acute lymphoblastic leukemia clinical effect was significant, under the monitoring of plasma MTX concentration, the implementation of personalized leucovorin rescue, minor toxic side effects, worthy of clinical promotion.