儿童急淋大剂量甲氨蝶呤延迟解救的安全性研究

目的 探讨大剂量使用甲氨蝶呤（HD-MTX）治疗儿童急性淋巴细胞白血病（ALL）后延迟6 h解救的安全性。方法 选择2006年1月~2018年12月在我院接受治疗的中高危ALL患儿108例作为研究对象，所有患儿均接受HD-MTX治疗，根据开始使用亚叶酸钙（CF）解救时间分为36H组及42H组，各54例。比较两组患儿的临床表现、常见不良反应情况及第2、3次解救后血药浓度。结果 36H组患儿骨髓抑制、口腔黏膜损害、胃肠道反应、肝功能异常、皮疹、继发感染发生率分别为81.48%（44/54）、20.37%（11/54）、24.07%（13/54）、44.44%（24/54）、11.11%（6/54）、11.11%（6/54），42H组分别为88.89%（48/54）、12.96%（7/54）、16.67%（9/54）、51.85%（28/54）、7.41%（4/54）、9.26%（5/54），组间比较，差异无统计学意义（P＞0.05）；两组第2、3次解救后血药浓度比较，差异无统计学意义（P＞0.05）。结论 ALL患儿接受HD-MTX治疗后42 h解救与36 h解救的安全性基本一致，但延迟6 h解救可以更好的发挥MTX的抗肿瘤作用。

Safety Study on Delayed Rescue of High-Dose Methotrexate in Children

Objective To investigate the safety of high-dose methotrexate (HD-MTX) in the treatment of children with acute lymphoblastic leukemia (ALL) after 6 h of rescue. Methods From January 2006 to December 2018, 108 children with middle and high risk ALL treated in our hospital were selected as the subjects. All the children were treated with HD-MTX. According to the rescue time of calcium folinate (CF), they were divided into 36H group (n=54) and 42H group (n=54). The clinical manifestations, common adverse reactions and blood concentration were compared between the two groups.Results The incidence of bone marrow suppression, oral mucosal damage, gastrointestinal reactions, liver dysfunction, rash and secondary infection in the 36H group were 81.48%（44/54）、20.37%（11/54）、24.07%（13/54）、44.44%（24/54）、11.11%（6/54）、11.11%（6/54）, 42H group, respectively. The differences were 88.89%（48/54）、12.96%（7/54）、16.67%（9/54）、51.85%（28/54）、7.41%（4/54）、9.26%（5/54）, respectively. There was no significant difference between the two groups (P>0.05). There was no significant difference in blood concentration between the two groups at the 2nd and 3rd time (P>0.05).Conclusion The safety of 42 h after HD-MTX treatment was consistent with the safety of 36 h rescue in children with ALL, but delayed 6 h rescue could better exert the anti-tumor effect of MTX.