[在患有急性淋巴细胞白血病的儿童中,MTHFR基因多态与甲状腺素代谢的关联]
Xiao-Dan Wang1, Jin-Wen Li1, Ping Zhang1
1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Institutes of Health Science, Tianjin 300020, China.
血清甲状腺素 (MTX) 水平和MTHFR基因变异会影响高剂量的MTX代谢和ALL儿童的毒性. 监测MTX水平是关键,MTHFR遗传学作为治疗的次要指南.
科学领域:
- 儿科瘤学 儿科瘤学
- 药物基因组学 药物基因组学
- 血液学 血液学 血液学
背景情况:
- 高剂量甲状腺素 (HD-MTX) 对于治疗急性淋巴细胞白血病 (ALL) 是至关重要的.
- 了解影响MTX代谢和毒性的因素对于优化治疗结果至关重要.
- 研究了MTHFR基因多态性对MTX药理动力学中的作用.
研究的目的:
- 评估血清MTX度,MTHFR基因多态 (C677T和A1298C) 和延迟的MTX代谢之间的关系.
- 评估这些因素与小儿ALL患者不良反应的关联.
- 为了确定延迟MTX代谢的风险因素.
主要方法:
- 对214名用HD-MTX治疗ALL的儿童进行了回顾性分析.
- 在HD-MTX给药后测量血清MTX度.
- 对于MTHFR C677T和A1298C多态的基因定型.
主要成果:
- 与CT基因型相比,MTHFR C677T TT和CC基因型与较高的延迟MTX代谢率有关.
- A1298C AC基因型与中性质衰竭风险增加相关.
- 升高的MTX水平与损伤,胃肠道问题和高白血症有关.
- 延缓新陈代谢的危险因素包括中等/高风险ALL,年龄大于14岁,BMI≥17kg/m2.
结论:
- 血清MTX度是MTX相关毒性的可靠指标.
- 单个MTHFR多态性单独不足以指导HD-MTX剂量调整.
- 建议采用综合方法,优先考虑MTX度监测,并将遗传因素作为辅助因素,用于治疗儿科ALL患者.
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