长期无病生存急性淋巴细胞白血病儿童神经认知功能及影响因素的研究

Neurocognitive function of children with acute lymphoblastic leukemia and long-term disease-free survival and related influencing factors

摘要:

目的 探讨长期无病生存急性淋巴细胞白血病（ALL）儿童的神经认知功能及影响因素。方法 以40例长期无病生存ALL儿童为研究对象，40例健康儿童为对照。采用中国修订韦氏儿童智力量表（C-WISC）、持续性操作测验（CPT）及Stroop测试软件对两组儿童进行测评，比较两组的神经认知功能并分析其影响因素。结果 长期无病生存ALL儿童C-WICS测验的总智商（FIQ）、言语智商（VIQ）、操作智商（PIQ）均低于对照组（P < 0.05）；CPT测试的错误数及漏答数高于对照组（P < 0.05）；Stroop测试字色一致的正确数、错误数、漏答数与对照组的差异无统计学意义（P > 0.05），字色矛盾及字色无关错误数、漏答数高于对照组（P < 0.05）。大剂量甲氨喋呤的总剂量、ALL危险分级与智商降低相关，初诊时年龄与漏答数、错误数得分相关，女性操作智商较低，差异均有统计学意义（P < 0.05）。结论 长期无病生存ALL儿童存在神经认知功能损害，可能与化疗药物剂量、诊断时的年龄、性别相关。

Abstract:

Objective To investigate the neurocognitive function of children with acute lymphoblastic leukemia (ALL) and long-term disease-free survival and related influencing factors.Methods A total of 40 ALL children with long-term disease-free survival were enrolled as study group, and 40 healthy children were enrolled as control group. The Chinese Wechsler Intelligence Scale for Children (C-WISC), continuous performance test (CPT), and Stroop test software were used for the evaluation of all children. Neurocognitive function was compared between groups and influencing factors were analyzed.Results Compared with the control group, the study group had significantly lower full intelligence quotient, verbal intelligence quotient, and performance intelligence quotient in C-WICS (P < 0.05) and significantly higher numbers of mistakes and misses in CPT (P < 0.05). There were no significant differences in the numbers of correct answers, mistakes, and misses of word-color consistency between the study group and the control group (P > 0.05), while the study group had significantly higher numbers of mistakes and misses of word-color contradiction and irrelevance (P < 0.05). The total dose of high-dose methotrexate and ALL risk classification were associated with the reduction in intelligence quotient, and children's younger age at diagnosis of ALL was associated with the higher numbers of misses and mistakes. Girls tended to have a significantly lower performance intelligence quotient than boys (P < 0.05).Conclusions ALL children with long-term disease-free survival have neurocognitive impairment, which may be associated with the dose of chemotherapeutic drugs, age at diagnosis, and sex.