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目的提高临床医生使用甲氨蝶呤的合理性和安全性,减少不良反应发生。方法 3例非霍奇金淋巴瘤患者大剂量使用甲氨蝶呤并用亚叶酸钙解救后,通过检测甲氨蝶呤血药浓度考察患者对甲氨蝶呤的代谢清除情况,利用MTHFR677C>T基因型检测、肝肾功能检查和药物相互作用分析,通过查阅文献资料分析甲氨蝶呤排泄延迟影响因素。结果 2例患者出现甲氨蝶呤排泄延迟,其原因可能与MTHFR677C>T基因多态性阳性、肝肾功能损伤及质子泵抑制剂与甲氨蝶呤联合用药相关。结论临床药师在药学服务中应发挥专业所长,密切关注甲氨蝶呤排泄情况,从而更好地协助临床医生降低甲氨蝶呤排泄延迟的发生,保证用药安全。
Objective To improve the rationality and safety of methotrexate for clinicians and reduce the incidence of adverse reactions. Methods Methotrexate was metabolized by methotrexate in three patients with non-Hodgkin’s lymphoma after high-dose methotrexate and calcium leucovorin. MTHFR677C> T gene Type detection, liver and kidney function tests and drug interactions analysis, access to literature data analysis of methotrexate excretion delay factors. Results The delayed excretion of methotrexate in 2 patients may be related to the positive MTHFR677C> T gene polymorphism, liver and kidney dysfunction and the combination of proton pump inhibitor and methotrexate. Conclusion Clinical pharmacists should play a professional role in pharmacy services, pay close attention to the excretion of methotrexate, so as to better help clinicians reduce the occurrence of methotrexate excretion delay and ensure the safety of medication.