浏览全部资源
扫码关注微信
MTHFR 基因多态性对骨肉瘤患者首次应用大剂量甲氨蝶呤后不良反应的影响Effects of
MTHFR gene polymorphism on the adverse reactions in osteosarcoma patients after the first high-dose methotrexate treatment- 中国药房 2024年35卷第1期 页码：80-83
- 作者机构：
东部战区总医院临床药学科，南京 210002
- 作者简介：
主管药师，硕士。研究方向：个体化基因给药。 E-mail：cyncpu@163.com
主管药师，硕士。研究方向：临床药学。电话：025-80860196。E-mail：liuxuejiao0615@163.com
- 基金信息：东部战区总医院临床诊疗新技术项目(22LCZLXJS56)
DOI：10.6039/j.issn.1001-0408.2024.01.14
中图分类号： R969.3纸质出版日期：2024-01-15，
收稿日期：2023-06-08，
修回日期：2023-12-08，
扫 描 看 全 文
初亚男,张婕妤,封利颖等.MTHFR基因多态性对骨肉瘤患者首次应用大剂量甲氨蝶呤后不良反应的影响 Δ[J].中国药房,2024,35(01):80-83.
CHU Yanan,ZHANG Jieyu,FENG Liying,et al.Effects of MTHFR gene polymorphism on the adverse reactions in osteosarcoma patients after the first high-dose methotrexate treatment[J].ZHONGGUO YAOFANG,2024,35(01):80-83.
初亚男,张婕妤,封利颖等.MTHFR基因多态性对骨肉瘤患者首次应用大剂量甲氨蝶呤后不良反应的影响 Δ[J].中国药房,2024,35(01):80-83. DOI： 10.6039/j.issn.1001-0408.2024.01.14.
CHU Yanan,ZHANG Jieyu,FENG Liying,et al.Effects of MTHFR gene polymorphism on the adverse reactions in osteosarcoma patients after the first high-dose methotrexate treatment[J].ZHONGGUO YAOFANG,2024,35(01):80-83. DOI： 10.6039/j.issn.1001-0408.2024.01.14.
摘要
目的
2
探讨MTHFR基因多态性对骨肉瘤患者首次应用大剂量甲氨蝶呤（HD-MTX）后不良反应的影响。
方法
2
采用前瞻性研究方法。选择东部战区总医院53例首次入院进行HD-MTX治疗的骨肉瘤患者，根据其人口学因素及
MTHFR
基因中rs1801133位点的基因多态性确定HD-MTX给药剂量并进行全程化药学监护，收集第1个化疗周期后该药的肝、肾、血液毒性和胃肠道反应数据。采用单因素分析和二元Logistic回归分析对MTX给药剂量、24 h血药浓度、rs1801133位点基因型与上述4种不良反应之间的相关性进行分析。
结果
2
CC野生型患者的MTX给药剂量显著高于TT突变型患者（7.97 g/m
2
vs. 6.98 g/m
2
，
P
＝0.030），但这种差异不影响MTX的0 h和24 h血药浓度。上述4种不良反应与MTX的给药剂量无相关性。二元Logistic回归分析结果显示，每携带一个T等位基因，患者发生血液学毒性的风险会升高4.13倍（95%置信区间为1.35～12.62，
P
＝0.013）。当MTX 24 h血药浓度阈值设定为2.65 μmol/L时，肝功能损害预测的灵敏度为53.33%，特异性为86.96%；当该阈值设定为7.28 μmol/L时，肾功能损害预测的灵敏度为100%，特异性为81.63%。
结论
2
MTHFR
基因中rs1801133位点的基因多态性与MTX的血液学毒性相关；首次应用HD-MTX并且携带T等位基因的患者，其血液学毒性风险较高。MTX 24 h血药浓度与该药的肝、肾毒性相关，监测患者的MTX 24 h血药浓度可以预测肝、肾毒性并及早采取干预措施。
Abstract
OBJECTIVE
2
To explore the effects of 5，10-methylenetetetrahydrofolate reductase （MTHFR） gene polymorphism on the adverse reactions in patients with osteosarcoma after the first high-dose methotrexate （HD-MTX） treatment.
METHODS
2
A prospective study was conducted to include 53 patients with osteosarcoma treated with HD-MTX at the first admission in General Hospital of Eastern Theater Command. The dose of MTX was evaluated according to the polymorphism of rs1801133 in the
METHFR
gene and demographic factors， then whole pharmaceutical monitoring was conducted. The data on liver toxicity， renal toxicity， hematological toxicity， and gastrointestinal reaction were collected after the first chemotherapy cycle. Single factor analysis and binary Logistic regression analysis were used to analyze the correlation between MTX dose， 24 h blood drug concentration， and rs1801133 locus genotype with four adverse reactions.
RESULTS
2
The MTX dosage in patients with CC wild type was significantly higher than that in TT mutant type （7.97 g/m
2
vs. 6.98 g/m
2
，
P
＝0.030）， but this difference did not affect the 0 h and 24 h blood drug concentrations of MTX. The above four adverse reactions were not related to the dose of MTX. The results of binary Logistic regression analysis showed that carrying one T allele increased the risk of developing hematological toxicity by 4.13 times（95% confidence interval：1.35-12.62，
P
＝0.013）. When 24 h plasma concentration threshold of MTX was set to 2.65 µmol/L， the sensitivity and specificity of predicting liver function damage were 53.33% and 86.96%， respectively； when the threshold was set to 7.28 μmol/L， the sensitivity and specificity of predicting renal damage were 100% and 81.63%.
CONCLUSIONS
2
The polymorphism of the rs1801133 in the
MTHFR
gene is associated with hematological toxicity of MTX. Patients who take HD-MTX for the first time and carry the T allele have a high risk of hematological toxicity. The 24 h plasma concentration of MTX is related to liver toxicity and renal toxicity. In addition， monitoring the 24 h blood drug concentration can predict liver and renal toxicity， and take early intervention measures.
关键词
甲氨蝶呤大剂量亚甲基四氢叶酸还原酶rs1801133位点不良反应基因多态性
Keywords
high-dose5，10-methylenete- trahydrofolate reductasers1801133 locusadverse reactionsgenetic polymorphism
references
JO V Y，FLETCHER C D M. WHO classification of soft tissue tumours：an update based on the 2013 （4th） edition[J]. Pathology，2014，46（2）：95-104.
SMRKE A，ANDERSON P M，GULIA A，et al. Future directions in the treatment of osteosarcoma[J]. Cells，2021，10（1）：172.
ZHANG Y，YANG J Q，ZHAO N，et al. Progress in the chemotherapeutic treatment of osteosarcoma[J]. Oncol Lett，2018，16（5）：6228-6237.
ZHANG W C，LIU Z Y，YANG Z M，et al. MTHFR polymorphism is associated with severe methotrexate-induced toxicity in osteosarcoma treatment[J]. Front Oncol，2021，11：781386.
ROBINSON A D，EICH M L，VARAMBALLY S. Dysregulation of de novo nucleotide biosynthetic pathway enzymes in cancer and targeting opportunities[J]. Cancer Lett，2020，470：134-140.
HURKMANS E G E，BRAND A C A M，VERDONSCHOT J A J，et al. Pharmacogenetics of chemotherapy treatment response and-toxicities in patients with osteosarcoma：a systematic review[J]. BMC Cancer，2022，22（1）：1326.
XIE L，GUO W，YANG Y，et al. More severe toxicity of genetic polymorphisms on MTHFR activity in osteosarcoma patients treated with high-dose methotrexate[J]. Oncotarget，2018，9（14）：11465-11476.
NAKARMI S，PUDASAINI K，ADHIKARI B，et al. Adverse events profile of low-dose methotrexate in Nepalese patients with rheumatoid arthritis：an observational study[J]. J Nepal Health Res Counc，2020，18（3）：360-365.
RAMSEY L B，BALIS F M，O'BRIEN M M，et al. Consensus guideline for use of glucarpidase in patients with high-dose methotrexate induced acute kidney injury and delayed methotrexate clearance[J]. Oncologist，2018，23（1）：52-61.
XIANG Z，LIU Y L，XING X Q，et al. Genotyping of alcohol dehydrogenase gene by pyrosequencing coupled with improved LATE-PCR using human whole blood as starting material：advances and clinical practice in pyrosequencing[M]. New York：Humana Press，2016：381-389.
XU M，WU S S，WANG Y，et al. Association between high-dose methotrexate-induced toxicity and polymorphisms within methotrexate pathway genes in acute lymphoblastic leukemia[J]. Front Pharmacol，2022，13：1003812.
SOLOMON D H，GLYNN R J，KARLSON E W，et al. Adverse effects of low-dose methotrexate：a randomized trial[J]. Ann Intern Med，2020，172（6）：369-380.
GILL J，GORLICK R. Advancing therapy for osteosarcoma[J]. Nat Rev Clin Oncol，2021，18（10）：609-624.
LILIENTHAL I，HEROLD N. Targeting molecular mechanisms underlying treatment efficacy and resistance in osteosarcoma：a review of current and future strategies[J]. Int J Mol Sci，2020，21（18）：6885.
RAGHUBEER S，MATSHA T E. Methylenetetrahydrofolate （MTHFR），the one-carbon cycle，and cardiovascular risks[J]. Nutrients，2021，13（12）：4562.
ALSDORF W H，KARAGIANNIS P，LANGEBRAKE C，et al. Standardized supportive care documentation improves safety of high-dose methotrexate treatment[J]. Oncologist，2021，26（2）：e327-e332.
BERNARD S，HACHON L，DIASONAMA J F，et al. Ambulatory high-dose methotrexate administration as central nervous system prophylaxis in patients with aggressive lymphoma[J]. Ann Hematol，2021，100（4）：979-986.
0
浏览量
1
下载量
0
CSCD
- 网络PDF下载
- WORD下载
- Meta-XML下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 地址：重庆市渝中区大坪正街129号四环大厦8层 400042
- 技术支持由北京北大方正电子有限公司提供 渝ICP备15012710号
公网安备50010302001817 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies