摘要
目的分析大剂量甲氨蝶呤(HD-MTX)治疗儿童颅内生殖细胞瘤延迟排泄的影响因素。方法纳入2016年6月至2018年7月北京市普仁医院收治的216例采用HD-MTX治疗的颅内生殖细胞瘤患儿的临床资料,对影响颅内生殖细胞瘤患儿HD-MTX延迟排泄的因素进行单因素和多因素分析。结果丙氨酸转氨酶(ALT)、天冬氨酸转氨酶、血清白蛋白、碱性磷酸酶、血肌酐异常组的MTX血药浓度超安全值占比均高于上述指标正常组[52.00%(13/25)比3.66%(7/191)、46.87%(15/32)比2.72%(5/184)、25.00%(18/72)比1.39%(2/144)、29.17%(14/48)比3.57%(6/168)、45.95%(17/37)比1.68%(3/179)](均P<0.01)。Logistic回归分析显示,ALT和血肌酐是评价MTX经亚叶酸钙解救后血药浓度超安全值的影响因素(OR=6.434,95%CI 1.567~26.412,P=0.010;OR=13.081,95%CI 2.712~63.103,P<0.001)。结论血肌酐和ALT是接受HD-MTX治疗颅内生殖细胞瘤患儿MTX延迟排泄的独立危险因素,治疗时应密切关注患者肝肾功能,确保用药安全。
Objective To analyze the factors affecting delayed excretion of high-dose methotrexate(HD-MTX)in treatment of intracranial germinoma of children.Methods The clinical data of 216 children with intracranial germinoma treated with HD-MTX in Beijing Puren Hospital from Jun.2016 to Jul.2018 were included,and univariate and multivariate analysis on the factors affecting delayed excretion of HD-MTX in children with intracranial germinoma was performed.Results The ultra-safe values of alanine aminotransferase(ALT),aspartate aminotransferase,serum albumin,alkaline phosphatase and serum creatinine in the abnormal group were higher than those in the normal group[52.00%(13/25)vs 3.66%(7/191),46.87%(15/32)vs 2.72%(5/184),25.00%(18/72)vs 1.39%(2/144),29.17%(14/48)vs 3.57%(6/168),45.95%(17/37)vs 1.68%(3/179)](all P<0.01).Logistic regression analysis showed that ALT and serum creatinine were influential factors for evaluating the ultra-safe value of MTX after calcuim folinate rescue(OR=6.434,95%CI 1.567-26.412,P=0.010;OR=13.081,95%CI 2.712-63.103,P<0.001).Conclusion Serum creatinine and ALT are independent risk factors for delayed MTX excretion in children with intracranial germinoma treated with HD-MTX.Liver and kidney functions of the patients should be paid close attention during treatment to ensure drug safety.
作者
赵嘉澍
梅升辉
王睿韬
路瑆
刘宇
赵志刚
ZHAO Jiashu;MEI Shenghui;WANG Ruitao;LU Xing;LIU Yu;ZHAO Zhigang(School of Pharmaceutical Sciences,Capital Medical University,Beijing 100069,China;Department of Pharmacy,Beijing Puren Hospital,Beijing 100062,China;Department of Pharmacy,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;the Second Clinical Division,Peking University School and Hospital of Stomatology/National Clinical Research Center for Oral Diseases/National Engineering Research Center of Oral Biomaterials and Digital Medical Devices/Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Medical Department,Beijing NO.6 Hospital,Beijing 100029,China)
出处
《医学综述》
CAS
2022年第7期1430-1434,共5页
Medical Recapitulate
基金
北京市医院管理局重点医学专业发展计划(ZYLX201827)。
关键词
颅内生殖细胞瘤
甲氨蝶呤
血药浓度
Intracranial germinoma
Methotrexate
Blood drug concentration
