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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[(24.35±4.84) pmol/L,(28.65±5.12) pmol/L]明显高于正常对照[(11.28±1.69) pmol/L](P<0.01);治疗获完全缓解后下降[(16.42±2.57) pmol/L,(14.57±3.64) pmol/L]但仍高于正常(P<0.05);完全缓解后6,12,24,36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<0.01).ALL和AML治疗前脑脊液中TNF-α水平[(12.35±1.74) pmol/L,(14.56±1.92) pmol/L]明显高于对照[(7.54±0.96) pmol/L],P0.05).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[(26.47±7.14) pmol/L vs (13.15±0.92) pmol/L],P<0.01.脑脊液TNF-α与脑脊液白细胞数呈正相关(r=0.942,P<0.05),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.结论血液和脑脊液TNF-α水平可反映白血病患者的肿瘤负荷及CNS的受累程度,是指导治疗的有益指标.“,”Objective To explore the changes and significance of tumor necrosis factor-alpha (TNF-α) in the serum and cerebrospinal fluid (CSF) of children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Methods TNF-α was measured by radioimmunoassay in 31 cases of childhood acute leukemia of various phases. Results Serum TNF-α levels pre-therapy in ALL and AML [(24.35±4.84) pmol/L, (28.65±5.12) pmol/L] were significantly higher than that of control [(11.28±1.69) pmol/L], P<0.01. Right after complete remission (CR), TNF-α decreased [(16.42±2.57) pmol/L, (14.57±3.64) pmol/L] but was higher than that of control (P<0.05). 6, 12, 24, 36 months after CR, serum TNF-α levels in ALL and AML returned to normal. Serum TNF-α increased again and was higher than that of control (P<0.01) when relapsed. CSF TNF-α pre-therapy in ALL and AML [(12.35±1.74) pmol/L, (14.56±1.92) pmol/L] were also significantly higher than that of control [(7.54±0.96) pmol/L] (P0.05). CSF TNF-α level in children with central nervous system leukemia (CNSL) was higher than those without CNSL [(25.62±7.14 pmol/L vs (12.15±0.89) pmol/L], P<0.01. There was a positive correlation between white blood cell count and TNF-α level in the CSF (r=0.942, P<0.05). CSF TNF-α level decreased gradually after intrathecal therapy, but it decreased more slowly than the white blood cells of CSF. Conclusions TNF-α concentration in the serum and CSF may be of great value in reflecting leukemic cell burden, early diagnosis of CNSL and monitoring intrathecal chemotherapy.