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叶酸代谢基因检测在甲氨蝶呤治疗白血病中的临床意义
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| 篇名： | 叶酸代谢基因检测在甲氨蝶呤治疗白血病中的临床意义 |
| TITLE： | Clinical significance of folic acid metabolic gene detection in methotrexate treatment of leukemia |
| 摘要： | 目的 探讨叶酸代谢基因检测在甲氨蝶呤（MTX）治疗急性髓系白血病（AML）中的临床意义。方法治疗药物监测（TDM）药师参与1例经鞘内注射MTX治疗后出现头晕、头痛、呕吐等神经系统毒副作用的AML患者的治疗过程，根据叶酸代谢基因MTHFRC677T（rs1801133）检测结果（突变纯合型）和MTX血药浓度监测结果（＜0.05μmol/L），结合患者临床表现，建议停用MTX，予亚叶酸钙静脉滴注进行解救，并考虑使用阿扎胞苷进行后续治疗。结果医生采纳TDM药师建议，患者经2次解救治疗后上述症状明显缓解，顺利出院。结论对于符合用药指征、接受鞘内注射MTX治疗的AML患者，可于用药前进行药物代谢遗传学检测和MTX药物浓度监测，以有助于医生及药师评估用药治疗方案的可行性，降低医疗风险。 |
| ABSTRACT： | OBJEC TIVE To expl ore the clinical significance of folic acid metabolic gene detection in methotrexate （MTX） treatment of acute myeloid leukemia （AML）. METHODS Therapeutic drug monitoring （TDM）pharmacists participated in the treatment process of an AML patient who had neurotoxic side effects such as dizziness ，headache，and vomiting after intrathecal injection of MTX. According to the results of the test of the folic acid metabolic gene MTHFR C677T（rs1801133）（mutant homozygous）and the results of MTX blood concentration monitoring （＜0.05 μmol/L），combined with clinical manifestations ，it was recommended to stop MTX ，give intravenous drip of calcium folinate for rescue ，and consider using azacytidine for follow-up treatment. RESULTS The doctor took the advice of TDM pharmacist ，and the above symptoms were significantly relieved after the patient rescued for 2 times and successfully discharged from the hospital. CONCLUSIONS For AML patients who meet the indications and receive intrathecal injection of MTX ，drug metabolism genetics testing and MTX drug concentration monitoring can be performed before medication ，which helps doctors and pharmacists evaluate the feasibility of drug treatment options and reduce medical risks. |
| 期刊： | 2022年第33卷第10期 |
| 作者： | 宋微微，黄月华，王兰，唐婧，毛乾泰，王建欣，艾超 |
| AUTHORS： | SONG Weiwei ，HUANG Yuehua ，WANG Lan，TANG Jing，MAO Qiantai ，WANG Jianxin ，AI Chao |
| 关键字： | 甲氨蝶呤；叶酸代谢基因检测；血药浓度监测；治疗药物监测药师；个体化药学监护 |
| KEYWORDS： | methotrexate；folic acid metabolic gene detection ；blood concentration monitoring ；therapeutic drug monitoring |
| 阅读数： | 423 次 |
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