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目的探讨进一步降低大剂量氨甲蝶呤(HDMTX)治疗小儿急性淋巴细胞白血病(ALL)毒副反应的方法。方法对2000年1月至2001年12月在上海儿童医学中心血液肿瘤科住院治疗的47例ALL患儿共进行的134例次HDMTX治疗,按照两种不同的水化、碱化方法,分为全国标准治疗组和观察组。观察患儿血清中的MTX浓度、治疗效果及毒副反应的发生率。结果(1)按WHO相关分度标准,各种毒副反应的发生率、Ⅲ度或Ⅲ度以上的毒副作用者的发生率两组比较差异有显著性意义。(2)观察组有2例次出现尿素氮的升高,标准治疗组未出现。(3)在应用HDMTX开始后44h、68h时血清MTX浓度异常者两组相比较差异有显著性意义。结论观察组HDMTX的毒副反应发生率及严重程度均明显低于全国标准治疗组,且减少治疗费用,而不影响HDMTX治疗效果。
Objective To explore a method to further reduce the toxicity of high dose methotrexate (HDMTX) in children with acute lymphoblastic leukemia (ALL). Methods A total of 134 HDMTX treatments were performed in 47 children with ALL who were hospitalized in Department of Hematology and Oncology, Shanghai Children’s Medical Center from January 2000 to December 2001. According to two different methods of hydration and alkalization, National standard treatment group and observation group. To observe the serum MTX concentration in children, the treatment effect and the incidence of toxic and side effects. Results (1) According to the relevant indexing standards of WHO, the incidence of various side effects and the incidence of toxic or side effects of grade Ⅲ or higher were significant difference between the two groups. (2) In the observation group, there were 2 cases of urea nitrogen increase, the standard treatment group did not appear. (3) There was a significant difference between the two groups in the serum MTX concentration at 44h and 68h after the start of application of HDMTX. Conclusions The incidence and severity of HDMTX in the observation group were significantly lower than those in the national standard treatment group, and the treatment cost was reduced, without affecting the HDMTX treatment effect.