大剂量甲氨蝶呤注射液排泄延迟致患儿多器官损伤1例分析

目的探讨大剂量甲氨蝶呤(HD-MTX)治疗儿童急性淋巴细胞白血病(ALL)致多器官损伤的防治措施。方法总结我院儿科2018年4月收治的1例男性患儿(11岁)因急性淋巴细胞白血病行大剂量甲氨蝶呤(6.6 g,5 g/m^2)化疗后出现多器官损伤的治疗方案。结果患儿首次静脉滴注MTX后,第2天出现呕吐、大便性状改变、发热、尿量减少,42 h MTX血药浓度为218μmol/L。第4天磷酸激酶升至173.2 U/L、肌苷最高达382.7μmol/L。考虑为MTX排泄延迟导致的多器官损伤。予亚叶酸钙0.1 g,每6 h 1次,同时给予水化碱化、血液透析、抗感染、止吐保肝等对症治疗后病情好转。结论使用HD-MTX可出现排泄延迟及器官损伤。治疗过程中应充分水化碱化,及时动态监测MTX血药浓度,以尽早采取有效措施,避免造成严重后果。

Multiple Organ Dysfunction in Children Induced by Delayed Elimination of High-dose Methotrexate Injection

Objective To investigate ways of prevention and treatment of multi-organ damage in children with acute lymphocyte leukemia(ALL),which is induced by high-dose methotrexate(HD-MTX).Methods The treatment plan of multi-organ damage in an 11-year-old boy with acute lymphocyte leukemia was summarized,who was treated with HD-MTX(6.6 g,5 g/m^2)in our pediatric department in April 2018.Results On the next day after the first intravenous infusion of MTX,the child manifested various symptoms of adverse reactions,such as vomiting,changes in stool characteristics,fever and decreased urine outputs.The blood concentration of MTX at 42 h was 218μmol/L.On the 4th day,the levels of phosphokinase and inosine were elevated to 173.2 U/L and 382.7μmol/L,respectively.It was suspected that the multiple-organ damage was induced by MTX excretion delay.Intravenous injection of calcium folinate was administrated at a dose of 100 mg every 6 h.Meanwhile,such symptomatic treatment as hydration alkalization,hemodialysis,anti-infection,antiemetic medication and liver protection was carried out.Subsequently,the patient completely recovered without further complications.Conclusion HD-MTX can cause delayed excretion and induce multi-organ damage.It is recommended that dynamic monitoring of the level of MTX in blood be implemented and immediate measures be taken,including sufficient hydration and alkalization,to reduce the occurrence of adverse reactions and ensure the safety of patients.