无病生存急性淋巴细胞白血病患儿体格生长发育与血清胰岛素样生长因子及结合蛋白水平关系的研究

Research of physical growth,level of insulin-like growth factor-1 and binding protein-3 in long-term survivors of childhood acute lymphoblastic leukemia

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 explore the correlation between physical growth state and serum level of insulin-like growth factor-1 （ IGF-1 ） as well as insulin-like growth factor binding protein-3 （ IGFBP-3 ） in long-term survivors of childhood acute lymphoblastic leukemia （ ALL）. Methods The beight,weight and body mass index （ BMI） of 82 long-term survivors of childhood ALL, who were treated according to the BCH-98 Protocol in Hematology Center of Beijing Children＇s Hospital from January 1998 to December 2002,were analyzed to evaluate their physical growth state. Serum levels of IGF- 1 and IGFBP-3 in 52 long-term survivors of childhood ALL were measured by radio-immunity assay. The correlation between the physical growth state and serum level of IGF-1 and IGFBP-3 was also studied. Results In the survivors,the height was in normal range. However, the weight was higher than normal standard and obesity was observed more frequently. Serum level of IGF-1 in survivors was higher than that of normal children. No effects of irradiation on serum level of IGF-1 and IGFBP-3 were observed. It was found that serum levels of IGF-1 and IGFBP-3 were correlated to weight and obesity in survivors. Moreover,serum level of IGF-1 was observed to be correlated with height in the survivors. Conclusion Long-term survivors of childhood ALL are in normal physical growth state, although obesity and increased serum level of IGF-1 can be observed.