MAC预处理骨髓移植后白血病患者甲状腺及肾上腺皮质功能的变化

Changes of thyroid and adrenocortical functions after bone marrow transplantation with MAC conditioning regimen in leukemia patients

目的：进一步了解ＭＡＣ（马法兰、阿糖胞苷和环磷酰胺）预处理方案对白血病患者骨髓移植后内分泌功能的影响。方法：用放射免疫法测定了２６例白血病患者用ＭＡＣ方案预处理骨髓移植（ＢＭＴ）前、后的甲状腺及肾上腺皮质功能。结果：所有患者ＢＭＴ前甲状腺及肾上腺皮质功能均正常。ＢＭＴ后１，３，６，１２，２４，３６，４８和６０个月时，血清中促肾上腺皮质激素（ＡＣＴＨ）及皮质醇（Ｃｒ）的平均水平与ＢＭＴ前比较无显著性差异（Ｐ＞０．０５）；ＢＭＴ后１，３及６个月，患者血清中促甲状腺素（ＴＳＨ）水平较移植前升高（Ｐ＜０．０１），７例患者发生甲状腺机能异常，其中６例在ＢＭＴ后６个月内逐渐恢复正常。结论：ＭＡＣ预处理方案对白血病患者肾上腺皮质功能无明显影响；ＢＭＴ后２８％患者出现甲状腺机能异常，但可在６个月内恢复正常，无需给予甲状腺素替代治疗。

Objective:To investigate the effect of MAC conditioning regimen on endocrine glands function in leukemia patients after bone marrow transplantation(BMT). Methods: Thyroid and adrenocortical functions were assayed by radioimmunoassay (RIA) in 26 leukemia patients before and after BMT. Results:All patients had normal thyroid and adrenocortical functions before BMT. As compared with that pre BMT, the median serum TSH levels were increased at 1,3 and 6 months post BMT(P<0.01). This thyroid dysfuncions were found in 7 of 26 patients, 6 of whom were recovered at 6 months post BMT. Conclusion: There was little effect of MAC conditioning regimen on adrenocortical function. Thyroid dysfunctions were found in 28%of the patients after BMT, and normalized in a short period without replacement therapy. 