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目的探讨大剂量甲氨蝶呤静滴+鞘内注射治疗急性淋巴细胞白血病(ALL)患儿时中枢神经系统损伤的监测指标。方法2003年1～12月在青岛大学医学院附属医院收治的42例标危ALL患儿中。在行大剂量甲氨蝶呤静滴+鞘内注射化疗前及化疗后15、30、45d腰穿留取脑脊液(CSF)各1mL,用双抗体夹心酶联免疫法测定CSF中神经元特异性烯醇化酶(NSE)的质量浓度。结果化疗后,CSF中NSE质量浓度升高,于第15天达峰值,化疗30dNSE质量浓度下降,与化疗前比较差异有统计学意义;化疗45d后NSE质量浓度与化疗前比较差异无统计学意义。结论CSF中NSE是ALL患儿行大剂量甲氨蝶呤静滴+鞘内注射化疗时,神经细胞急性损伤的一个有价值的预报因子。
Objective To investigate the monitoring of central nervous system injury in children with acute lymphoblastic leukemia (ALL) treated with intravenous methotrexate and intrathecal injection. Methods From January to December 2003, 42 cases of ALL children with ALL were admitted to Affiliated Hospital of Qingdao University Medical College. In the line of large doses of methotrexate infusion + intrathecal chemotherapy before and after chemotherapy 15, 30, 45d lumbar puncture and retention of CSF (CSF) were 1mL, double antibody sandwich enzyme-linked immunosorbent assay for neuronal specificity in CSF Enolase (NSE) mass concentration. Results After chemotherapy, the concentration of NSE in CSF increased and reached its peak on the 15th day. The concentration of NSE decreased on the 30th day after chemotherapy, which was significantly different from that before chemotherapy. There was no significant difference in NSE concentration between the two groups . Conclusions NSE in CSF is a valuable predictor of acute neuronal injury in ALL children undergoing high-dose methotrexate infusion and intrathecal chemotherapy.