大剂量氨甲蝶呤治疗急性淋巴细胞性白血病15例不良反应分析

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。

ANALYSIS OF THE ADVERSE EFFECTS IN THE TREATMENT OF ACUTE LYMPHOBLASTIC LEUKEMIA WITH HIGH DOSE OF METHOTREXATE

Objective To explore the clinical indications in the treatment of acutelymphoblastic leukemia(ALL) with high dose of methotrexate (HD--MTX) and to observe the adverse effects and other impacts on hepatic and renal functions. Methods Theadverse effects and tolerance ill the treatment were recorded and studied. Results All thepatients could tolerate the treatment. Poor appetite,vomiting,lower fever headache,diarrhea and oral ulcer occurred with the proportion of 36/45, 13/45,8/45, 6/45, 4/45and 3/45 respectively. The treatment mainly caused the dropping of WBC in the peripheralblood. The RBC and platelets were less affected. Some patients (9/45 ) were found tohave AST rises for some time,hut they could recover in a few days. No effects on renalfunctions were found in the treatment. Conclusion After the patients' bone marrow hasgot complete remission, the liver and renal functions can return to normal,and all thesick children can endure this kind of treatment.