儿童急性白血病不同治疗阶段血液和脑脊液TNF-α变化的研究(英文)

Serum and Cerebrospinal Fluid TNF-α in Children with Acute Leukemia of Various Phases

摘要:

目的：探讨急性白血病儿童血液和脑脊液中肿瘤坏死因子(TNF-α)的变化及其临床意义。方法：采用放射免疫分析法检测31例儿童急性白血病治疗前、完全缓解时及连续完全缓解期血液和脑脊液TNF-α水平。结果：急性淋巴细胞白血病(ALL)和急性髓细胞白血病(AML)治疗前血液TNF-α水平［(24.35±4.84) pmol/L，(28.65±5.12) pmol/L］明显高于正常对照［(11.28±1.69) pmol/L］(P<0.01)；治疗获完全缓解后下降［(16.42±2.57) pmol/L，(14.57±3.64) pmol/L］但仍高于正常(P<0.05)；完全缓解后6，12，24，36个月稳定在正常水平；但复发时血清TNF-α又明显升高，高于对照组(P<0.01)。ALL和AML治疗前脑脊液中TNF-α水平［(12.35±1.74)pmol/L，(14.56±1.92) pmol/L］明显高于对照［(7.54±0.96) pmol/L］，P<0.01；完全缓解后和持续完全缓解期它们与对照组差异无显著性(P>0.05)。合并中枢神经系统白血病(CNSL)者脑脊液TNFα明显高于未合并CNSL者［(26.47±7.14)pmol/L vs (13.15±0.92) pmol/L］，P<0.01。脑脊液TNFα与脑脊液白细胞数呈正相关(r=0.942，P<0.05)，经鞘内注射治疗后脑脊液中TNFα逐步恢复正常，但较白细胞恢复慢。结论：血液和脑脊液TNF-α水平可反映白血病患者的肿瘤负荷及CNS的受累程度，是指导治疗的有益指标。

Abstract:

OBJECTIVE: To explore the changes and significance of tumor necrosis factor alpha (TNF α) in the serum and cerebrospinal fluid (CSF) of children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Methods TNF α was measured by radioimmunoassay in 31 cases of childhood acute leukemia of various phases. RESULTS: Serum TNF α levels pre therapy in ALL and AML [( 24.35 ± 4.84 ) pmol/L, ( 28.65 ± 5.12 ) pmol/L] were significantly higher than that of control [( 11.28 ± 1.69 ) pmol/L], P< 0.01 . Right after complete remission (CR), TNF α decreased [( 16.42 ± 2.57 ) pmol/L, ( 14.57 ± 3.64 ) pmol/L] but was higher than that of control (P< 0.05 ). 6, 12, 24, 36 months after CR, serum TNF α levels in ALL and AML returned to normal. Serum TNF α increased again and was higher than that of control (P< 0.01 ) when relapsed. CSF TNF α pre therapy in ALL and AML [( 12.35 ± 1.74 ) pmol/L, ( 14.56 ± 1.92 ) pmol/L] were also significantly higher than that of control [( 7.54 ± 0.96 ) pmol/L] (P< 0.01 ). During CR and continuous CR, CSF TNF α in ALL and AML patients remained at the level of control (P> 0.05 ). CSF TNF α level in children with central nervous system leukemia (CNSL) was higher than those without CNSL [( 25.62 ± 7.14 pmol/L vs ( 12.15 ± 0.89 ) pmol/L], P< 0.01 . There was a positive correlation between white blood cell count and TNF α level in the CSF (r= 0.942 , P< 0.05 ). CSF TNF α level decreased gradually after intrathecal therapy, but it decreased more slowly than the white blood cells of CSF. CONCLUSIONS: TNF α concentration in the serum and CSF may be of great value in reflecting leukemic cell burden, early diagnosis of CNSL and monitoring intrathecal chemotherapy.