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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 [(2 4 .35± 4 .84 )pmol/L ,(2 8.6 5± 5 .12 ) pmol/L]明显高于正常对照 [(11.2 8± 1.6 9) pmol/L](P <0 .0 1) ;治疗获完全缓解后下降 [(16 .4 2± 2 .5 7) pmol/L ,(14 .5 7± 3.6 4 ) pmol/L]但仍高于正常 (P <0 .0 5 ) ;完全缓解后 6 ,12 ,2 4 ,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 .0 1)。ALL和AML治疗前脑脊液中TNF α水平[(12 .35± 1.74 ) pmol/L ,(14 .5 6± 1.92 ) pmol/L]明显高于对照 [(7.5 4± 0 .96 ) pmol/L],P <0 .0 1;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 .0 5 )。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 [(2 6 .4 7± 7.14 ) pmol/Lvs (13.15± 0 .92 ) pmol/L],P <0 .0 1。脑脊液TNF α与脑脊液白细胞数呈正相关 (r=0 .94 2 ,P <0 .0 5 ) ,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 ?
Objective To investigate the changes of tumor necrosis factor (TNF) in blood and cerebrospinal fluid (CSF) of children with acute leukemia and its clinical significance. Methods Radioimmunoassay was used to detect the levels of TNFα in blood and cerebrospinal fluid of 31 children with acute leukemia before treatment, complete remission and continuous complete remission. Results The levels of blood TNFα in patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) before treatment [(24.34 ± 4.84) pmol / L, (21.65 ± 5.12) pmol / L] Was significantly higher than that of the control group [(11.2 8 ± 1.6 9) pmol / L] (P <0.01); The treatment was decreased after complete remission [(16.42 ± 2.57) pmol / L, .5 7 ± 3.6 4 pmol / L], but still higher than normal (P <0.05). After complete remission 6, 12, 24, 36 months stabilized at normal levels; Obviously higher than the control group (P <0.01). The levels of TNFα in cerebrospinal fluid before treatment in ALL and AML groups were significantly higher than those in control [(7.54 ± 0.96) pmol / L [(12.35 ± 1.74) pmol / L, (14.56 ± 1.92) pmol / L] ], P <0.01; after complete remission and continuous complete remission, they had no significant difference with the control group (P> 0.05). The cerebrospinal fluid TNFα in patients with central nervous system leukemia (CNSL) was significantly higher than those without CNSL [(26.74 ± 7.14) pmol / Lvs (13.15 ± 0.92) pmol / L], P <0.01 . CSF α and cerebrospinal fluid leukocyte number was positively correlated (r = 0.94 2, P <0.05), after intrathecal injection of TNF α in cerebrospinal fluid gradually returned to normal, but slower than leukocyte recovery. in conclusion ?