1例急性淋巴细胞白血病儿童大剂量甲氨蝶呤 化疗后中毒解救的病例分析

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【中图分类号】R97 【文献标识码】A

A case analysis of high-dose methotrexate toxicity management in a child with acute lymphoblastic leukemia

YANG Qian1²2， GAO Li³， HE Hailong²，HU Shaoyan²，ZHOU Mi1

1.DepartmentofPharmacy，Children'sHospitalAfiliated to Soochow University，Suzhou 215000，JiangsuProvince，China2.PharmacyDepartmentofTaicang FirstPeople's Hospital， Taicang 2154oo，Jiangsu Province，China3.DepartmentofHematology，Children'sHospital Afiliated to Soochow University，Suzhou215000，Jiangsu Province，China

Corresponding author： ZHOU Mi， Email： zhoumi007@126.com

【Abstract】An 8-year-old male child with acute lymphoblastic leukemia （ALL） developed signs of methotrexate （MTX） toxicity-such as vomiting，chest tightnes，and rapidly elevated serum creatinine and uric acid levels-on the second day after his first high-dose methotrexate （HDMTX） treatment. The toxicity is considered due to delayed excretion of methotrexate. The clinical pharmacist asssted the medical team in formulating a treatment plan that included adequate hydration and alkalinization， leucovorin rescue，and subsequent dose adjustment of MTX， based on therapeutic drug monitoring and pharmacogenetic testing results. By day 11， the patient's MTX plasma concentration， serum creatinine，and uric acid levels had returned to safe ranges. In this case，theclinical pharmacists used pharmaceuticalknowledge to analyze potential factors contributing to delayed MTX elimination，and asisted the treatment team to improve the safetyand efficacy of drug therapy.This case provides valuable experience for the standardized management of similar pediatric patients.

【Keywords 】High-dose methotrexate; Delayed excretion; Acute lymphoblastic leukemia; Clinica pharmacist; Safe drug use

甲氨蝶呤（methotrexate，MTX）是一种抗叶酸类抗肿瘤药物，进入细胞后转化为多聚谷氨酸盐形式（polyglutamyl，MTX-PG），通过抑制二氢叶酸还原酶，阻碍二氢叶酸向四氢叶酸转化，能选择性作用于细胞的S期，从而抑制肿瘤细胞的生长与繁殖]。（剩余10913字）