大剂量甲氨蝶呤治疗白血病的临床效果观察及不良反应预防

目的 观察大剂量甲氨蝶呤治疗急性淋巴细胞白血病（ALL）的临床效果和不良反应.方法 来源于我院血液科ALL患者92例,随机分为观察组和对照组各46例.观察组应用大剂量甲氨蝶呤＋长春新碱＋环磷酰胺＋吡柔比星化疗方案治疗;对照组予柔红霉素＋长春新碱＋泼尼松＋左旋门冬酰胺酶治疗方案.比较两组的临床疗效、病情缓解所需疗程及不良反应发生情况.结果 观察组总有效率为84.78％ （39/46）,对照组为80.43％ （37/46）,两组差异无统计学意义（x2=0.45,P＞0.05）.观察组病情缓解需（1.26±0.28）疗程,对照组为（1.31±0.31）疗程,两组差异无统计学意义（t=2.13,P＞0.05）.观察组初治完全缓解率为75.00％ （24/32）、复治为50.00％（4/8）、难治为33.33％ （2/6）;对照组分别为76.67％（23/30）、50.00％（4/8）、25.00％（2/8）,两组差异无统计学意义（x2 =0.98,P＞0.05）.观察组患者骨髓抑制发生率（23.91％）明显低于对照组（43.48％）,而肝肾功能损伤发生率（54.35％）明显高于对照组（17.39％）,差异有统计学意义（P均＜ 0.05）.观察组患者5年生存率为67.39％,对照组为45.65％,两组比较差异有统计学意义（P＜0.05）.结论 大剂量甲氨蝶呤用于治疗ALL临床效果确切,不良反应尚可耐受.

Clinical observation and prevention of side reaction of high dose methotrexate in the treatment of leukemia

Objective To analyze the clinical efficacy,adverse events and corresponding preventive measures of high dose methotrexate in the treatment of acute lymphoblastic leukemia（ALL）.Methods Ninety-two patients with ALL who hospitalized in Heamotology Department of Jinshan Hospital Affiliated to Fudan University were randomly divided into observation group and control group,and each group had 46 cases.Patients in observation group were given high dose melhotrexate ＋ vincristine ＋ cytoxan ＋ pirarubicin chemotherapy treatment,and in control group were given soft red enzyme ＋ vincristine ＋ metacortan dracin ＋ L-asparaginase treatment.The clinical efficacy,adverse events and the required course of remission of two groups were compared.Results The total effective rate in the observation group was 84.78%,while it was 80.43% in the control group,and there was no statistically significant difference （x2 =0.45,P 〉 0.05）.The average remission was （1.26 ± 0.28） in the observation group,while （1.31 ± 0.31） in the control group,and no significant difference was observed （t =2.13,P 〉 0.05）.The complete remission rate of initial treatment,retreatment and refractory were 75.00% （24/32）,50.00% （4/8） and 33.33% （2/6） respectively in observation group,while 76.67% （23/30）,50.00% （4/8） and 25.00% （2/8） respectively in control group,and there was no statislically significant difference between two groups （x2 =0.98,P 〉0.05）.The rate of bone marrow suppression in the observation group（23.91%） was lower than that in the control group（43.48%）,while the rate of liver and kidney injury（54.35%） was higher than that inthe control group（17.39%）,which showed significant difference （P 〈 0.05）.The survival rate of 5 years in observation group was 67.39%,while 45.65% in control group,and there was statistically significant difference between two groups （P 〈 0.05）.Conclusion The high dose methotrexate in the treatment of acute lymphoblastic leukemia was proved