静脉高剂量甲氨蝶呤（MTX ≥ 1 g/m2）经常用于患有脑淋巴瘤或其他恶性肿瘤的患者。除了其强效治疗作用外，它还具有明显的毒性和危及生命的副作用。需要定期的短期监测。本研究旨在评估用中心静脉导管取代外周血采样进行甲氨蝶呤治疗监测在成人中的可行性。总共6名患者和7个化疗周期（6名女性；5名脑非何杰金淋巴瘤患者和1名骨肉瘤患者，中位年龄51岁；范围33-62岁）。采用免疫分析法定量分析 MTX 水平。测量点在24、42、48和72小时以及此后每24小时一次，直到水平低于<0.1 µmol/L。用10 mL盐水冲洗并丢弃10 mL静脉血后，通过之前注射MTX的中心静脉通路抽取血液。同时，从外周静脉穿刺处获得MTX水平。中心静脉通路的MTX水平和外周静脉穿刺处的MTX水平显示显著相关（r = 0.998；P <0.01；n = 35）。在从中心通路组提取血液时，17个值显示MTX水平较低，10个值显示水平较高，8个值无差别。然而，MTX水平差异并不显著（P = 0.997，线性混合模型）。根据收集到的MTX水平，不需要增加碳酸叶酸的剂量。在成人中，从中心静脉通路监测MTX不逊于外周静脉穿刺监测MTX。在确立适当采样的标准化指示后，可以用中心静脉导管替换重复的静脉穿刺来测量MTX水平。版权所有©2023 Wolters Kluwer Health，Inc.。保留所有权利。

Intravenous high-dose methotrexate (MTX ≥ 1 g/m2) is frequently used in patients with cerebral lymphoma or other malignancies. In addition to its potent efficacy, it is known to have pronounced toxicity and life-threatening side effects. Regular-level monitoring at short and defined intervals is mandatory. This study aimed to evaluate the possibility of replacing peripheral blood sampling with blood samples from central venous catheters for therapeutic monitoring of MTX in adults.A total of 6 patients and 7 cycles of chemotherapy (6 females; 5 with cerebral non-Hodgkin lymphoma and 1 with osteosarcoma, median age 51 years; range 33-62 years) were included. An immunoassay was used for quantitative analysis of MTX levels. The measurement points were obtained in the time intervals of 24, 42, 48, and 72 hours, and afterward, every 24 hours until the level was below <0.1 µmol/L. After flushing with 10 mL of saline solution and discarding 10 mL of venous blood, blood was drawn from the central venous access through which MTX had previously been administered. Simultaneously, MTX levels were obtained from peripheral venipuncture.Methotrexate levels from central venous access and MTX levels from peripheral venipuncture showed a significant correlation (r = 0.998; P < 0.01; n = 35). During withdrawal from the central access group, 17 values showed a lower MTX level, 10 showed a higher level, and 8 showed no difference. However, the MTX level difference was not significant (P = 0.997, linear mixed model). No increase in the dose of calcium folinate was necessary based on the collected MTX levels.In adults, MTX monitoring from central venous access is not inferior to monitoring from peripheral venipuncture. Repeated venipuncture to measure MTX levels can be replaced after establishing standardized instructions for proper sampling by a central venous catheter.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.