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目的探讨长期无病生存的急性淋巴细胞白血病(ALL)血清胰岛素样生长因子-1(IGF-1)和胰岛素样生长因子结合蛋白-3(IGFBP-3)的变化与体格生长发育状态的关系。方法选取1998年1月至2002年12月在首都医科大学附属北京儿童医院血液中心接受BCH-98方案化疗且目前停止治疗无病生存的ALL患儿82例,测定其身高、体质量,计算出体质量指数(BMI),分析长期无病生存的ALL患儿的体格生长发育状态。通过免疫放射量度分析法测定其中52例ALL患儿的IGF-1和IGFBP-3水平,并对IGF-1、IGFBP-3水平与ALL患儿体格生长发育状态的相互关系进行分析。结果长期无病生存ALL患儿的身高均在正常范围。体质量较正常儿童有所增加,肥胖儿童增多。长期无病生存ALL患儿的IGF-1水平较正常儿童升高;放疗对IGF-1和IGFBP-3水平并无影响。IGF-1和IGFBP-3与停止治疗后的体质量及肥胖相关,IGF-1还与停止治疗后的身高相关。结论长期无病生存的ALL患儿虽然存在肥胖及IGF-1水平增高,但体格生长发育状态大致处于正常水平。
Objective To investigate the relationship between the changes of serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) in long-term disease-free survival and the growth and development status of the patients with acute lymphoblastic leukemia. METHODS: From January 1998 to December 2002, 82 children with ALL who were treated with BCH-98 regimen in the blood center of Beijing Children’s Hospital Affiliated to Capital University of Medical Sciences and currently stopped treatment of disease-free survival were selected and their height and body weight were measured. Body mass index (BMI), analysis of long-term disease-free survival of ALL children’s physical growth and development status. The levels of IGF-1 and IGFBP-3 in 52 children with ALL were determined by immuno-radiation assay. The relationship between IGF-1 and IGFBP-3 levels and physical growth and development of children with ALL was analyzed. Results Long-term disease-free survival of children with ALL in the normal range. Body mass increased compared with normal children, an increase of obese children. Long-term disease-free survival of children with elevated levels of IGF-1 than normal children; radiotherapy on IGF-1 and IGFBP-3 levels had no effect. IGF-1 and IGFBP-3 are associated with body weight and obesity after discontinuation of treatment, and IGF-1 is also associated with postoperative height. Conclusions Despite the presence of obesity and elevated IGF-1 levels in children with long-term disease-free ALL, physical growth and development are generally at normal levels.