PDF(Pubmed)
Abstract：
BACKGROUND: Low-dose methotrexate has a relatively good safety profile. However, in cases where patients with multiple risk factors, a delayed excretion has been observed, resulting in the occurrence of severe adverse reactions. It is necessary to supervise and intervene throughout the entire process of treating patients with multiple risk factors for methotrexate, and to strengthen the rational application of methotrexate.
METHODS: A 66-year-old male patient was admitted to our hospital with rheumatoid arthritis and underlying conditions such as chronic obstructive pulmonary disease (COPD). This patient received treatment with low-dose MTX (10 mg/week) and experienced adverse reactions including anemia. He was diagnosed with methotrexate-induced bone marrow suppression.
RESULTS: The therapeutic drug monitoring revealed that the serum drug concentration of methotrexate was at a critical level and the patient was rescue with calcium folinate and other adjuvant therapy such as transfusions of red blood cells, plasma, platelets, oral Yixuesheng tablets and Leucogen tablets. We conducted a 1-month follow-up, and there was no recurrence of bone marrow suppression and anemia.
CONCLUSIONS: To ensure rational administration of methotrexate, it is important to fully evaluate the clinical manifestations and physical condition of patients and regularly detecting the serum drug concentration of methotrexate when patients with multiple risk factors, Otherwise, even low-dose methotrexate administration may cause delayed excretion, resulting in severe adverse reactions.
METHODS: A 66-year-old male patient was admitted to our hospital with rheumatoid arthritis and underlying conditions such as chronic obstructive pulmonary disease (COPD). This patient received treatment with low-dose MTX (10 mg/week) and experienced adverse reactions including anemia. He was diagnosed with methotrexate-induced bone marrow suppression.
RESULTS: The therapeutic drug monitoring revealed that the serum drug concentration of methotrexate was at a critical level and the patient was rescue with calcium folinate and other adjuvant therapy such as transfusions of red blood cells, plasma, platelets, oral Yixuesheng tablets and Leucogen tablets. We conducted a 1-month follow-up, and there was no recurrence of bone marrow suppression and anemia.
CONCLUSIONS: To ensure rational administration of methotrexate, it is important to fully evaluate the clinical manifestations and physical condition of patients and regularly detecting the serum drug concentration of methotrexate when patients with multiple risk factors, Otherwise, even low-dose methotrexate administration may cause delayed excretion, resulting in severe adverse reactions.
摘要：
背景：低剂量甲氨蝶呤具有相对良好的安全性。然而,在具有多种危险因素的患者中，已经观察到延迟的排泄，导致严重不良反应的发生。有必要在甲氨蝶呤多重危险因素患者的治疗过程中进行全程监督和干预，加强甲氨蝶呤的合理应用。
方法：一名66岁的男性患者因类风湿关节炎和慢性阻塞性肺疾病（COPD）等基础疾病入院。该患者接受低剂量MTX（10mg/周）治疗，并出现不良反应，包括贫血。他被诊断为甲氨蝶呤诱导的骨髓抑制。
结果：治疗药物监测显示，甲氨蝶呤的血清药物浓度处于临界水平，患者正在接受亚叶酸钙和其他辅助治疗，如输血红细胞，等离子体,血小板,口服益血生片和致光片。我们进行了为期一个月的随访,无骨髓抑制和贫血复发。
结论：为了确保甲氨蝶呤的合理给药，当患者存在多种危险因素时,充分评估患者的临床表现和身体状况,定期检测甲氨蝶呤的血清药物浓度,否则,即使低剂量甲氨蝶呤给药也可能导致排泄延迟，导致严重的不良反应。
方法：一名66岁的男性患者因类风湿关节炎和慢性阻塞性肺疾病（COPD）等基础疾病入院。该患者接受低剂量MTX（10mg/周）治疗，并出现不良反应，包括贫血。他被诊断为甲氨蝶呤诱导的骨髓抑制。
结果：治疗药物监测显示，甲氨蝶呤的血清药物浓度处于临界水平，患者正在接受亚叶酸钙和其他辅助治疗，如输血红细胞，等离子体,血小板,口服益血生片和致光片。我们进行了为期一个月的随访,无骨髓抑制和贫血复发。
结论：为了确保甲氨蝶呤的合理给药，当患者存在多种危险因素时,充分评估患者的临床表现和身体状况,定期检测甲氨蝶呤的血清药物浓度,否则,即使低剂量甲氨蝶呤给药也可能导致排泄延迟，导致严重的不良反应。
