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1.
目的观察大剂量甲氨蝶呤(Methothexate,MTX)治疗儿童急性淋巴细胞白血病的副作用。方法对10例47例次急性淋巴细胞白血病(acute lymphobalstic leukemia,ALL)患儿进行大剂量甲氨蝶呤连续24h持续静脉滴注,第42h四氢叶酸钙(FH4)解救,检测44h MTX血药浓度,观察副作用发生率。结果副作用主要为肝功能损害。口腔黏膜糜烂、肛周糜烂、消化道症状,1例引起严重的剥脱性皮炎。结论大部分患儿对于大剂量MTX的副反应可耐受,极少数会引起严重的不良反应。  相似文献   

2.
目的 观察GSTT1、GSTM1基因多态性与急性淋巴细胞白血病(ALL)易感性及大剂量甲氨蝶呤(HD-MTX)血药浓度、所致急性肝损伤的相关性。方法 选取2016年6月—2021年2月福建医科大学附属协和医院血液科收治的ALL患者92例为病例组,体检中心的健康体检者185例为对照组。采用课题组改良的多重PCR法对病例组、对照组进行GSTT1、GSTM1基因分型,比较不同基因型与ALL易感性、HD-MTX所致急性肝损伤的相关性,基因型与MTX血药浓度的相关性。结果 GSTM1基因多态性与ALL易感性和HD-MTX所致急性肝损伤的发生存在相关性(P=0.001/0.004),GSTM1(-)增加二者发生风险,OR=2.451/3.596,95%CI(1.462~4.116)/(1.464~8.836),未发现GSTT1基因多态性与二者的相关性;不同基因型C44 h/D组间比较差异均无统计学意义(P>0.05)。结论 GSTM1(-)显著增加ALL及HD-MTX治疗所致肝损伤的发生风险,提示GSTM1酶蛋白在血液疾病发生和机体抵抗药物与环境毒物损伤方面的重要作用。  相似文献   

3.
目的:在儿童急性淋巴细胞白血病(ALL)患者中,探讨亚甲基四氢叶酸还原酶(MTHFR C677T和A1298C)基因多态性与甲氨蝶呤(MTX)化疗后44 h血药浓度和严重毒副反应间的相关性。方法:收集77例ALL患儿临床资料,监测MTX输注后44 h的血药浓度并进行MTHFR基因分型;分析MTHFR C677T基因型和A1298C基因型与MTX 44 h血药浓度及严重毒副反应间的相关性。结果:MTHFR C677T、A1298C各基因型与MTX 44 h血药浓度间均无统计学差异(P>0.05)。未发现MTHFR C677T基因多态性与MTX化疗后严重毒副反应间存在相关性(P>0.05)。MTHFR A1298C杂合突变型(AC)相比野生型(AA),发生血红蛋白减少的风险增加(P=0.002),未发现其他严重毒副反应与MTHFR A1298C基因多态性间存在相关性(P>0.05)。结论:MTHFR A1298C基因多态性可能与ALL患儿MTX化疗后血红蛋白减少有一定相关性。  相似文献   

4.
目的 探讨成熟B细胞淋巴瘤患儿ABCB1 C3435T(CC型、CT型和TT型)基因多态性与大剂量甲氨蝶呤(HD-MTX)化疗后血药浓度和药品不良反应(ADR)的相关性。方法 回顾性收集本院2019年10月1日至2022年10月1日收治的行HD-MTX化疗且检测ABCB1 C3435T基因型并测定MTX血药浓度的成熟B细胞淋巴瘤患儿的病历资料,分析基因多态性与MTX血药浓度和ADR的关系。结果 共收集66例患者,其中男52例,女14例,平均年龄(7.46±3.09)岁(1.9~15.0岁)。HD-MTX化疗后常见ADR为中性粒细胞减少(98.48%)、贫血(89.39%)、血小板减少(77.27%)和黏膜损伤(53.03%)等。ABCB1 C3435T TT型比CC型的MTX 44 h血药浓度更高(P<0.05)。CT和TT型比CC型的黏膜损伤、呕吐和肝损伤发生率更高(P <0.05)。结论 ABCB1 C3435T基因多态性与成熟B细胞淋巴瘤患儿HD-MTX血药浓度水平及ADR(黏膜损伤、呕吐和肝损伤)可能有关。  相似文献   

5.
摘 要 目的:研究急性淋巴细胞白血病(ALL)患儿多药耐药基因1(ABCB1)基因多态性与使用大剂量甲氨蝶呤(MTX)化疗期间的血药浓度及不良反应的关系。方法: 70例ALL患儿外周血,提取DNA,采用PCR技术和直接测序的方法分析ABCB1基因的基因型;采用酶放大免疫法(EMIT)测定MTX给药后48h的血药浓度;2.华中科技大学同济医学院同济医院药学部,统计不良反应相关信息。分析ABCB1基因多态性与MTX血药浓度及不良反应的关系。结果: ABCB1 C3435T位点存在多态性,ABCB1 C3435T位点患儿CC、CT和TT基因型的分布频率分别为31.43%,47.14%,21.43%。ABCB1 C3435T位点各基因型MTX 48h C/D值由低到高依次为CC型患儿、CT型患儿、TT型患儿,其中TT型与CC型之间差异具有统计学意义(P<0.05)。ABCB1 C3435T位点不同基因型患者中,口腔黏膜损害、肝脏损害发生率差异有统计学意义(P<0.05)。结论:ABCB1 C3435T位点基因多态性与ALL患儿大剂量MTX化疗后的血药浓度及不良反应(口腔黏膜炎、肝脏损害)有关。  相似文献   

6.
《中国药房》2019,(24):3428-3433
目的:研究MTRR基因rs1801394位点、SLCO1B1基因rs11045879位点多态性与急性淋巴细胞白血病(ALL)患儿甲氨蝶呤(MTX)血药浓度及大剂量甲氨蝶呤(HD-MTX)致不良反应的相关性。方法:回顾性收集2015年10月-2018年9月四川省人民医院收治的接受HD-MTX治疗且处于巩固化疗期的四川地区汉族ALL住院患儿70例,采用均相酶扩大免疫法检测患儿给药后48、72 h时的血药浓度,采用实时荧光定量聚合酶链反应法检测其基因分型;分析MTRR、SLCO1B1基因多态性与MTX血药浓度[剂量校正浓度(c48 h/D,48 h)、不同血药浓度范围(≤0.1、>0.1μmol/L)患儿比例(72 h)]及不良反应(骨髓抑制、肝功能损害、胃肠道反应、黏膜损伤、皮疹等)的相关性;采用Wald渐进法对不同影响因素(基因多态性、MTX血药浓度、免疫分型、体质量指数等)与不良反应的相关性进行二元Logistic回归分析。结果:共检出MTRR基因AA、AG、GG型患儿31、32、7例,SLCO1B1基因TT、TC、CC型患儿23、37、10例,各基因型频率均符合Hardy-Weinberg平衡(P>0.05)。MTRR和SLCO1B1各基因型患儿c48 h/D(48 h)以及不同血药浓度范围患儿比例(72 h)比较差异均无统计学意义(P>0.05)。MTRR各基因型患儿肝功能损害发生率差异显著(P<0.05),且AA型显著高于AG+GG型(P<0.05);而MTRR基因多态性与其他不良反应发生率,SLCO1B1基因多态性与各不良反应发生率均不相关(P>0.05)。二元Logistic回归分析结果显示,ALL患儿肝功能损害与MTRR基因多态性相关,胃肠道反应与72 h血药浓度>0.1μmol/L与否相关,黏膜损伤与患儿免疫分型和体质量指数相关,皮疹与患儿体质量相关(P<0.05)。结论:MTRR基因rs1801394位点多态性可能与ALL患儿HD-MTX致肝功能损害的发生相关,但该多态性和SLCO1B1基因rs11045879位点多态性均与患儿体内MTX的血药浓度无关。  相似文献   

7.
目的分析大剂量甲氨喋呤(MTX)治疗小儿急性淋巴细胞性白血病(ALL)的血药浓度结果,并探讨其临床意义。方法应用荧光偏振免疫法(FPIA),选择接受43次大剂量MTX化疗的急性淋巴细胞白血病患儿21例,定时采血测定MTX的血药浓度。结果应用MTX后44 h,血药浓度>10μmol/L 1例;应用72 h血药浓度>1μmol/L 3例,仅1例患儿出现严重口腔消化道黏膜炎及皮肤损伤,其余无不可逆的严重不良反应发生。结论患儿应用MTX的有效血药浓度个体差异大。MTX血药浓度的监测,对实施个体化给药及ALL患儿临床合理用药有着重要意义。  相似文献   

8.
目的:观察大剂量甲氨蝶呤(MTX)连续24 h持续静脉输注治疗儿童急性淋巴细胞白血病的临床耐受性。方法:72例次急性淋巴细胞白血病患儿进行大剂量甲氨蝶呤连续24 h持续静脉输注,第36 h亚叶酸钙解救,检测36 h4、8 h、72 h MTX血药浓度,观察不良反应发生率。结果:不良反应表现为消化道症状、肝功能损害和Ⅰ°~Ⅱ°白细胞减少、Ⅰ°~Ⅱ°口腔粘膜损害,无严重不良反应发生。92.5%的患儿72 h MTX血药浓度<0.1μmol/L。结论:大剂量MTX加亚叶酸钙解救治疗儿童急性淋巴细胞白血病,耐受性较好。个别患儿出现排泄延迟,通过监测MTX血药浓度,增加亚叶酸钙解救次数,可防止严重不良反应发生。  相似文献   

9.
目的 研究GSTP1和SLCO1B1基因多态性与儿童急性淋巴细胞白血病(ALL)患儿使用大剂量甲氨蝶呤(HD-MTX)化疗后出现排泄延迟及不良反应的相关性及预测价值。方法 选择2021年1月至2022年12月南京医科大学附属儿童医院80例ALL患儿为研究对象,采用聚合酶链式反应(PCR)法测定所有患儿GSTP1(rs1695、rs537387344)和SLCO1B1(rs2306283、rs4149056)等位点的基因多态性,采用均相酶扩大免疫分析(EMIT)法测定MTX血药浓度,记录在接受HD-MTX治疗过程中发生的不良反应。用单因素分析GSTP1和SLCO1B1基因多态性、HD-MTX排泄延迟及不良反应的相关性,并得出显著性因素;用多因素Logistic回归筛选出预测因子,绘制受试者工作特征(ROC)曲线评价预测价值。结果 SLCO1B1 rs4149056 TC与排泄延迟具有相关性;72 h血药浓度、GSTP1 rs1695 AA、SLCO1B1 rs4149056 TC基因型与MTX化疗后不良反应的发生具有相关性,差异有统计学意义(P <0.05)。ROC曲线分析结果表明...  相似文献   

10.
目的:观察大剂量甲氨蝶呤(MTX)连续24 h持续静脉输注治疗儿童急性淋巴细胞白血病临床安全性.方法:50例急性淋巴细胞白血病患儿进行196例次大剂量甲氨蝶呤连续24 h持续静脉输注,第42 h亚叶酸钙解救,检测44 h、68 h MTX浓度,观察不良反应发生情况.结果:不良反应表现为口腔粘膜损害、皮肤损害、消化道症状...  相似文献   

11.
目的:探讨亚甲基四氢叶酸脱氢酶1(MTHFD1)G1958A基因多态性与急性淋巴细胞白血病(ALL)患儿使用大剂量甲氨蝶呤(HD-MTX)化疗期间的MTX血药浓度及不良反应的关系。方法:收集70例急性淋巴细胞白血病患儿外周血,提取DNA,采用PCR技术和直接测序的方法分析MTHFD1基因的基因型;采用酶放大免疫法(EMIT)测定MTX给药后48 h的血药浓度;收集患者HD-MTX化疗期间的临床资料,统计不良反应相关信息,对化疗不良反应进行分级。分析MTHFD1基因多态性与MTX血药浓度及不良反应的关系。结果:MTHFD1 G1958A基因位点存在多态性,70例ALL患儿中GG、AG和AA基因型的分布频率分别为41.43%,52.86%,5.71%; G和A等位基因的分布频率分别为67.86%和32.14%。携带野生基因型(GG)ALL患儿的48hC/D值高于突变型基因型(GA+AA)携带者;携带野生基因型(GG)ALL患儿的骨髓抑制和肝脏损害不良反应发生率高于携带突变基因型(GA+AA)ALL患儿。由于个体间差异大,上述差异均无统计学意义( P>0.05)。结论:影响MTX的体内代谢和不良反应的因素复杂,MTHFD1 G1958A多态性尚不能作为ALL患儿HDMTX化疗所致骨髓移植和肝脏损害不良反应和预测MTX体内排泄的有效预测指标。  相似文献   

12.
Polymorphisms in chemical metabolizing genes are known to influence individual susceptibility to environmental cancer. We investigated the role of GSTM1 and GSTT1 polymorphisms in modifying the genotoxicity of a tobacco-specific nitrosamine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) using the sister chromatid exchange (SCE), and the tandem-probe fluorescence in situ hybridization chromosome aberration (CA) assays. NNK (0.24, 0.72 or 1.44 mM) induced a significant concentration-dependent increase in the mean number of SCE regardless of genotypes. In comparing the effects between genotypes, significant increase was observed in GSTM1 null cells compared with GSTM1 positive cells only at the low concentration of NNK (0.24 mM). No significant difference was observed between cells with the null and positive GSTT1 genotypes. Using the CA assay, treatment with NNK (0.12, 0.24 or 0.72 mM) induced a significant concentration-dependent increase in the frequency of CA. In addition, cells with the null GSTM1 genotype had significantly increased CA compared with cells with GSTM1 positive genotype at the three concentrations of NNK. Regarding GSTT1 polymorphism, no significant effect was observed between the null and the positive genotypes. Treatment of the cells with 1 mM glutathione monoethyl ester (GSHME) significantly reduced NNK-induced CA in all cells regardless of their genotypes. The effect was clearly more evident in cells with the GSTM1 positive genotype. Therefore, GSHME is protective against NNK-induced CA with more dominant effect in cells with the GSTM1 positive genotype. Our study indicates that GSTM1 may influence NNK-induced genotoxicity and subsequent tobacco-related health effects.  相似文献   

13.
The measurement of the pyrene metabolite, 1-hydroxypyrene, in human urine has been used to assess recent exposure to polycyclic aromatic hydrocarbons (PAH). The objective of this study was to see whether genetic polymorphisms in metabolic enzymes could explain some of the variation in urinary 1-hydroxypyrene glucuronide (1-OHPG) excretion in relation to smoking. Forty-seven male hospital workers, who were not occupationally exposed to PAH, participated in this study. The urine samples were analyzed for 1-OHPG utilizing immunoaffinity chromatography and synchronous fluorescence spectroscopy. The analysis of GSTM1 and GSTT1 polymorphism was performed by PCR. The 1-OHPG concentration in the urine of the hospital workers was 0.57 +/- 0.85 micromol/mol creatinine, and ranged from 0.02 to 5.04 mciromol/mol creatinine. Cigarette smoking was significantly correlated with urinary 1-OHPG (r = 0.3976, P = 0.0056). The 1-OHPG excretion in GSTM1-deficient smokers was higher than that in GSTM1-positive smokers. On the other hand, 1-OHPG excretion was higher in GSTT1-positive smokers than in GSTT1-deficient smokers. It is important to note the variability of individual PAH metabolite excretion due to different GSTM1 and GSTT1 genotypes.  相似文献   

14.
目的 探讨汉族人群谷胱甘肽S转移酶M1(GSTMl)和T1(GSTT1)基因多态性与抗结核药物性肝损害(ATDLI)易感性的关系.方法 回顾性分析抗结核治疗后发生肝损害的结核病患者228例(病例组)及未发生肝损害的结核病患者300例(对照组),应用多重PCR技术检测其GSTM1和GSTT1基因多态性.结果 病例组与对照组GSTM1基因缺失型频率分别为58.3%和50.7%,差异无统计学意义(OR=1.363,95%CI=0.963~1.929); GSTT1基因缺失型频率分别为45.2%和49.3%,差异也无统计学意义.联合分析也未发现两种基因在抗结核药物性肝损害发生中具有协同作用.结论 汉族人群GSTM1和GSTT1基因多态性与抗结核药物性肝损害的发生无关.  相似文献   

15.
Environmental tobacco smoking (ETS) is known to be associated with adverse pregnancy outcomes. The purpose of this study was to investigate the relationship between maternal exposure to ETS and oxidative stress for neonates, as well as the effect of maternal genetic polymorphisms, glutathione-S-transferase M1 (GSTM1) and GSTT1, on this relationship. We used the radioimmunoassay to measure the urinary concentration of cotinine in 266 pregnant women who denied smoking cigarettes during pregnancy and in their singleton babies. In addition, the urinary concentration of malondialdehyde (MDA) and 8-hydroxy-2-deoxyguanosine (8-OH-dG) were assessed using high-performance liquid chromatography and enzyme-linked immunosorbent assay, respectively. We also extracted DNA from whole blood obtained from the mothers and then conducted polymerase chain reaction on the samples to determine the GSTM1 and GSTT1 genotypes. The maternal cotinine concentration was found to be significantly associated with the fetal cotinine concentration, particularly for mothers whose urine cotinine concentrations were above 120 microg/gcr (p<0.01). The fetal urine cotinine concentration was also found to be significantly associated with the fetal urine MDA concentration (p<0.01). When the null type maternal GSTM1 or the wild type GSTT1 was present, the maternal oxidative stress level increased significantly as the maternal continine concentration increased (MDA: p<0.01; 8-OH-dG: p<0.01). No significant relationships were found between maternal cotinine and fetal oxidative stress markers, however, the fetal MDA levels increased significantly as fetal cotinine levels increased. These results suggest that the maternal exposure to ETS affects the fetal urine cotinine concentration and induces production of maternal oxidative stress. In addition, maternal genetic polymorphisms of GSTM1 and GSTT1 may modify the oxidative stress by maternal exposure to ETS.  相似文献   

16.
目的:探讨女性乳腺癌人群中GSTT1基因、GSTM1基因多态性在乳腺癌发生发展中的作用。为筛选易感人群、早期诊断及有效地预防和治疗措施的建立提供参考依据。方法:采用聚合酶链反应(PCR)、限制性片段长度多态性(RFLP)及琼脂糖凝胶电泳法对105例正常人和100例乳腺癌患者GSTT1基因、GSTM1基因的多态性分布进行检测,Logistic回归等方法估计基因、基因与乳腺癌相关危险因素的交互作用对乳腺癌发病的危险度。结果:GSTT1、GSTM1基因和乳腺癌的危险性呈负相关,OR(95%CI)分别为0.322(0.175~0.593)和0.340(0.188~0.615);GSTT1基因与GSTM1基因的交互作用和乳腺癌的发病有统计学关联,GSTM1基因和GSTT1基因同时缺失的人群OR(95%CI)为12.338(3.621~22.042);GSIT1基因及GSTM1基因与多个乳腺癌相关危险因素存在交互作用。结论:GSIT1、GSTM1基因的缺失是乳腺癌发病的危险因素;特定的环境暴露背景下,基因在与环境危险因素的相互作用促进乳腺癌的发生。  相似文献   

17.
The present study was conducted (1) to examine whether the GSTT1- and GSTM1-null genotypes are risk factors for bladder cancer, and (2) to study possible association of tobacco usage and age strata with genotype of these patients. This case control study was undertaken over a period of 19 months and included 106 bladder cancer patients and 182 controls; both patients and controls originated from northern part of India. The GSTT1 and GSTM1 genotypes were identified by multiplex PCR in peripheral blood DNA samples. Genotype frequencies among patients and controls were assessed and the association of the genotypes with smoking habits and gender of the patients were statistically determined by the 2 test. Frequencies of null genotypes in GSTT1 and GSTM1, were 16% (29/182) and 30% (54/182), respectively, in control individuals. The frequencies of GSTT1- and GSTM1-null genotypes in bladder cancer patients were 26% (28/106) and 40% (42/106), respectively. In conclusion, our study demonstrated that the null genotypes of GSTT1 and GSTM1 were substantially at higher risk for bladder carcinoma compared to the normal healthy controls. The GSTT1- and GSTM1-null genotypes did not show significant association with tobacco usage in bladder cancer patients. However, the null genotypes were statistically significant in female relative to male bladder cancer patients.  相似文献   

18.
INTRODUCTION: Glutathione S-transferases (GSTs) are considered to be cancer susceptibility genes as they play a role in the detoxification of carcinogenic species. This study aimed to elucidate the influence of several GST polymorphisms on colorectal and gastric cancer risk. PATIENTS AND METHODS: GST mu1 (GSTM1), theta1 (GSTT1), pi1 (GSTP1), alpha1 (GSTA1) and mu3 (GSTM3) genotypes were determined in 144 colorectal cancer patients, 98 gastric cancer patients and 329 healthy control individuals. RESULTS: Colorectal cancer: the risk is greater for carriers of the GSTM1 null genotype (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.25-2.91), for carriers of the GSTT1 null genotype (OR = 3.62, 95% CI = 2.34-5.62), and for simultaneous carriers of both GSTM1 and GSTT1 null genotypes (OR = 4.98, 95% CI = 2.77-9.00). Carriers of the GSTP1 104 Val/Val genotype are at a lower risk (OR = 0.31, 95% CI = 0.09-0.88). Among carriers of the GSTP1 Ile/Ile genotype, smoking increases the risk compared with nonsmoking (OR = 2.35, 95% CI = 1.11-4.99). Gastric cancer: the risk is greater for carriers of the GSTT1 null genotype (OR = 2.58, 95% CI = 1.53-4.36) and for simultaneous carriers of both GSTM1 and GSTT1 null genotypes (OR = 3.32, 95% CI = 1.62-6.77). Carriers of the GSTP1 104 Val/Val genotype are at a lower risk (OR = 0.20, 95% CI = 0.02-0.86). DISCUSSION: The GSTT1 null genotype, particularly if it is associated with the GSTM1 null genotype, greatly increases the risk for colorectal and gastric cancers. The GSTP1 104 Val/Val genotype may protect from both malignant tumors. CONCLUSION: This study indicates that GST polymorphisms, in particular the GSTM1/GSTT1 double-null haplotype, can be considered low-penetrance genes for gastrointestinal cancer.  相似文献   

19.
【摘要】目的 研究乳腺癌外周血中谷胱甘肽转硫酶(GST)M1、GSTT1和GSTP1(rs1695)基因多态性与乳腺癌患者采用蒽环类和(或)紫杉类药物化疗发生血液毒性的关系。方法 应用多重PCR技术(M-PCR)和高分辨熔解曲线技术(HRM)检测3个基因在252例女性乳腺癌患者外周血中的基因多态性。结果 采用紫杉类、蒽环联合紫杉类药物化疗,携带GSTP1(rs1695)AG/GG的患者是发生Ⅲ~Ⅳ度中性粒细胞减低的危险因素(OR=6.111, 95%CI1.526~24.469, P<0.05和OR=9.257, 95%CI2.903~29.522, P<0.01),而GSTM1(+)与GSTM1(-)、GSTT1(+)与GSTT1(-)患者Ⅲ~Ⅳ度血液毒性的发生率差异均无统计学意义;采用蒽环类药物化疗,GSTM1(+)和GSTM1(-)、GSTT1(+)和GSTT1(-)、GSTP1AA和GSTP1AG/GG患者Ⅲ~Ⅳ度血液毒性发生率差异均无统计学意义(P>0.05)。结论 GSTP1(rs1695)基因多态性可作为预测乳腺癌患者采用紫杉类药物化疗发生中性粒细胞毒性的标志。  相似文献   

20.
目的 研究急性淋巴细胞白血病(ALL)儿童的ABCB1 C3435T位点(rs1045642)基因多态性与大剂量甲氨蝶呤(HD-MTX)化学治疗后血浆中甲氨蝶呤血药浓度和不良反应的相关性.方法 选取2015年8月至2019年6月于我院小儿血液内科住院治疗的132例ALL患儿,在接受HD-MTX治疗前应用聚合酶链反应(P...  相似文献   

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