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目的观察儿童急性淋巴细胞白血病(ALL)大剂量甲氨蝶呤(HDMTX)疗法MTX排泄延迟的发生率和不良反应,探讨MTX排泄延迟与MTX剂量、用药方式的关系,及如何减少排泄延迟的发生。方法分析121例497例次儿童ALLHDMTX化疗的临床资料,比较有和无排泄延迟情况下HDMTX的不良反应。并按剂量(3g组和5g组)和用药持续时间(7h组和24h组)分组,比较排泄延迟的发生率、不良反应及各组四氢叶酸钙(CF)的解救剂量。结果总体排泄延迟发生率为12.1%,发生1次排泄延迟的相对概率是30.6%,再次发生的相对概率为45.9%,明显增加(P<0.01)。有排泄延迟的患儿排泄延迟时血小板较无排泄延迟时明显减低(P<0.01),CF解救剂量明显增加(P<0.01)。3g组排泄延迟时口腔黏膜损害较无排泄延迟时更明显(P<0.05),下一疗程化疗延迟(中位延迟4d)。3g组排泄延迟发生率(12.1%)与5g组(12.0%)比较差异无统计学意义(P>0.05),7h用药组排泄延迟发生率(13.6%)与24h用药组(11.9%)比较差异也无统计学意义(P>0.05)。无排泄延迟时5g组仅胃肠道反应较3g组明显增加(P<0.01),而CF解救剂量明显低于3g组(P<0.01)。结论HDMTX排泄延迟情况下骨髓抑制和口腔黏膜损害的不良反应增加,下一疗程化疗延迟,CF用量增加。HDMTX排泄延迟在3～5g/m2剂量范围里与MTX剂量、用药方式无关,而与
Objective To investigate the incidence and adverse reactions of excretion of MTX excreted by high dose methotrexate (HDMTX) therapy in children with acute lymphoblastic leukemia (ALL) and to explore the relationship between MTX excretion delay and MTX dosage and drug administration and how to reduce the excretion delay . Methods The clinical data of 121 cases with ALLHDMTX chemotherapy in 497 children were analyzed. Adverse reactions of HDMTX with or without excretion delay were compared. The dosage of 3g group and 5g group and the duration of treatment group (7h group and 24h group) were divided into groups to compare the incidence of excretion delay, adverse reactions and rescue dose of calcium folinate in each group. Results The overall excretion delay was 12.1%, the relative probability of excretion delay was 30.6%, and the relative probability of recurrence was 45.9% (P <0.01). In excretion delayed excretion of platelet release delay was significantly reduced (P <0.01), CF rescue dose was significantly increased (P <0.01). 3g group excretion delay oral mucosal damage than without delay more obvious (P <0.05), the next course of chemotherapy delay (median delay 4d). The incidence of excretion delay in 3g group (12.1%) was not significantly different from that in 5g group (12.0%) (P> 0.05). The incidence of excretion delay in 13h group was significantly lower than that in 24h group (11.9%) Nor statistically significant (P> 0.05). In the 5g group without excretion delay, only the gastrointestinal reaction was significantly increased (P <0.01) compared with the 3g group, while the CF rescue dose was significantly lower than the 3g group (P <0.01). Conclusions Adverse reactions to myelosuppression and oral mucosal damage were increased with excretion of HDMTX, and chemotherapy was delayed and the amount of CF increased during the next course of treatment. HDMTX excretion delay in the 3 ~ 5g / m2 dose range with the MTX dose, the drug has nothing to do, and