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| 弥漫大B细胞淋巴瘤患者大剂量甲氨蝶呤血药浓度监测及影响因素分析 |
| Monitoring of plasma methotrexate concentrations and analysis of associated factors in patients with diffuse large B-cell lymphoma receiving high-dose methotrexate therapy |
| 投稿时间：2025-10-07 |
| DOI：10.3969/j.issn.1000-0399.2026.07.001 |
| 中文关键词: 大剂量甲氨蝶呤 弥漫大B细胞淋巴瘤 血药浓度 影响因素 不良反应 |
| 英文关键词: High-dose methotrexate Diffuse large B-cell lymphoma Drug concentration Influencing factors Adverse reactions |
| 基金项目:安徽省卫生健康科研项目(编号:AHWJ2024BAg30001) |
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| 中文摘要: |
| 目的 探讨大剂量甲氨蝶呤（HD-MTX）应用于弥漫大B细胞淋巴瘤（DLBCL）患者时，甲氨蝶呤血药浓度的影响因素及不良反应发生情况。方法 回顾性分析中国科学院合肥肿瘤医院2023年8月至2025年1月使用HD-MTX治疗的11例DLBCL患者的临床资料，记录患者基本信息，采用酶放大免疫测定法测定甲氨蝶呤（MTX）静脉滴注开始后第24、48、72小时的血药浓度(C24h、C48h、C72h)，同时记录治疗过程中发生的不良反应。采用非参数检验及多元线性回归分析MTX血药浓度的影响因素。结果 11例确诊DLBCL的患者，共接受HD-MTX化疗39次。单因素分析结果显示，合并使用质子泵抑制剂（PPIs）、同时合并使用PPIs+非甾体抗炎药（NSAIDs）对C24h有影响（P<0.05）；合并使用PPIs对C48h有影响（P<0.05）。多元线性回归分析结果显示，合并使用PPIs是C24h的主要影响因素（P<0.05），方差膨胀系数为3.27。HD-MTX不良反应发生率为79.48%，其中胃肠道反应和骨髓抑制最常见。结论 在HD-MTX治疗DLBCL的过程中，需考虑患者合并使用PPIs的情况，重点关注患者胃肠道反应和血液毒性。 |
| 英文摘要: |
| Objective To explore the factors influencing methotrexate plasma concentrations and adverse reactions incidence in patients with diffuse large B-cell lymphoma（DLBCL） receiving high-dose methotrexate（HD-MTX）. Methods A retrospective analysis of 11 patients with DLBCL treated with HD-MTX at the Hefei Cancer Hospital of the Chinese Academy of Sciences from August 2023 to January 2025. Enzyme-multiplied immunoassay technique was used to measure the plasma concentrations of methotrexate 24, 48, and 72 hours(C24h, C48h, C72h) after the start of intravenous infusion, while adverse reactions occurring during treatment were recorded. Multivariate analysis and multiple linear regression analysis were used to identify the factors influencing MTX plasma concentrations. Results A total of 11 patients diagnosed with DLBCL were included in this study, who received a total of 39 cycles of HD-MTX chemotherapy. Results of univariate analysis showed that the concomitant use of proton pump inhibitors（PPIs） and the combined use of PPIs + nonsteroidal anti-inflammatory drugs（NSAIDs） had a significant effect on C24h（P< 0.05）. The concomitant use of PPIs had a significant effect on C48h)（P< 0.05）. Multivariate linear regression analysis showed that concomitant PPIs use was the primary factor affecting C24h（P< 0.05）, with a variance inflation factor of 3.27. The incidence of HD-MTX adverse reactions was 79.48%, with gastrointestinal reactions and bone marrow suppression being the most common. Conclusion During HD-MTX treatment for DLBCL, consideration should be given to the patient's concurrent use of PPIs. Special attention should be paid to gastrointestinal reactions and hematological toxicity. |
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