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目的 探讨急性白血病患儿血液和脑脊液 (CSF)肿瘤坏死因子 (TNF α)变化及其临床意义。方法 采用放射免疫分析法检测急性白血病 31例患儿治疗前、完全缓解 (CR)时、连续CR期血液和CSF中TNF α水平。结果 急性淋巴细胞白血病 (ALL) 2 1例和急性髓细胞白血病 (AML) 10例治疗前血液TNF α分别为(2 4 .35± 4 .84 ) pmol/L、(2 8.6 5± 5 .12 )pmol/L ,明显高于 13例正常对照 (11.2 8± 1.6 9) pmol/L(t=3.12 ,3.2 7 P均 <0 .0 1) ,获CR后降至正常 ,并在连续CR期稳定在正常水平 ,但复发时血TNF α又明显升高。ALL和AML治疗前CSF中TNF α分别为 (12 .35± 1.74 ) pmol/L和 (14 .5 6± 1.92 ) pmol/L ,明显高于 7例正常对照[(7.5 4± 0 .96 ) pmol/L](t=2 .97,3.13 P均 <0 .0 1)。并中枢神经系统白血病 (CNSL)CSF中TNF α明显高于未并CNSL者 [(2 6 .4 7± 7.14 )pmol/L ,(13.15± 0 .92 ) pmol/L ,t=3.2 4 P均 <0 .0 1],并与CSF中白细胞数增高程度呈正相关 (r=0 .94 2 P <0 .0 5 ) ,经鞘内注射治疗后TNF α渐恢复正常 ,但较白细胞恢复慢。结论 血液和CSF中TNF α水平可反映白血病患儿的肿瘤负荷及CNS受累程度 ,是指导治疗的有益指标
Objective To investigate the changes of tumor necrosis factor (TNF) in blood and cerebrospinal fluid (CSF) in children with acute leukemia and its clinical significance. Methods Thirty-one children with acute leukemia were treated with radioimmunoassay before and after complete remission (CR). Results The blood levels of TNFα in 21 cases of acute lymphoblastic leukemia (ALL) and 10 cases of acute myeloid leukemia (AML) before treatment were (24.34 ± 4.84) pmol / L, (2 8.65 ± 5.12 ) pmol / L, which was significantly higher than that of 13 normal controls (11.28 ± 1.6 9 pmol / L, t = 3.12, 3.2 7 P <0.01) Stable at normal levels, but the recurrence of blood TNFα was significantly higher. The levels of TNFα in ALL and AML before treatment were (12.35 ± 1.74) pmol / L and (14.56 ± 1.92) pmol / L, respectively, which were significantly higher than those in 7 normal controls [(7.54 ± 0.96) pmol / L] (t = 2.97, 3.13 P <0.01). (P <0.05), and TNFα in central nervous system leukemia (CNSL) CSF was significantly higher than that in patients without CNSL [(26.74 ± 7.14) pmol / L, <0.01), which was positively correlated with the increase of white blood cell count in CSF (r = 0.94 2 P <0.05). After intrathecal injection, TNF α gradually returned to normal but recovered slowly compared with leukocyte. Conclusion The level of TNF-α in blood and CSF can reflect the tumor burden and the degree of CNS involvement in children with leukemia, which is a useful indicator of treatment