儿童淋巴细胞白血病应用左旋门冬酰胺酶对糖代谢的影响

Adverse Influense of Glycometabolism Caused by L-asParaginase in Children Used In Acute LymPhoblastic Leukemia

左旋门冬酰胺酶(L-asparaginase,L-asp)是临床主要使用的抗肿瘤药物之一,也是治疗儿童急性淋巴细胞白血病(Acutelym-phocytic leukemia,ALL)的主要药物之一,它通过耗竭肿瘤细胞中的天冬酰胺来产生抗肿瘤的效果,会对儿童体内的糖代谢产生不良的影响,造成血糖的异常升高,严重的会导致酮症酸中毒。L-asp引起血糖升高通常被认为是由于药物引起的免疫反应,导致胰岛素受体下降造成的。近年的观点则认为是L-asp直接损害了胰岛中的B细胞的结构和功能而引起。目前临床对于L-asp引起的血糖升高采取的措施是停用药物和使用胰岛素。

L--asparaginase（L--asp）is a useful drug to treat some formes of malignant disease,inclosed in children with acute lyrnphoblastic leukemia. L--asp killed the tumor cell by depletion of its amino acid asparagines.One of L--asp＇ s sever toxicities in children is hyperglycemia and some case will develop ketoacidosis.The mechanism of hyperglycemia was that the number of insulin receptor had decreased.However,rencently research showed a direct toxic effect to B cell associated with structural and functional alternation. When hyperglycemia happens ceasing therapy and treating with insulin should be taken.