左卡尼汀对柔红霉素诱导的急性淋巴细胞白血病患儿血浆N末端脑利钠肽原的影响

Effects of levocarnitine oral solution on the plasma N-terminal pro-brain natriuretic peptide levels in children with acute lymphocytic leukemia treated by daunorubicin

目的:通过观察急性淋巴细胞白血病患儿应用柔红霉素(daunorubicin,DNR)化疗后其血浆N末端脑利钠肽原(N-terminal pro-brain natriureticpeptide,NT-pro BNP)水平的改变及应用左卡尼汀心肌保护药物后NT-pro BNP水平的变化,探讨能早期监测DNR心肌毒性并可筛选出更好保护心肌药物的指标。方法:选择2006-2008年新诊断的急性淋巴细胞白血病患儿22例,均采用长春新碱+柔红霉素+左旋门冬酰胺酶+泼尼松(VDLP)方案诱导化疗,化疗期间分别应用左卡尼汀口服液(Levocarnitine oral solution)(治疗组)或未予任何心肌保护药物(对照组)。在应用DNR前后用交体基免疫分析法测定患儿血浆NT-proBNP水平,并同时常规检测患儿化疗前后心肌肌钙蛋白I(cTnI)、心肌酶谱(LDH1、CPK-MB)及心电图(ECG)。结果:治疗组(L-CN组)患儿化疗后血浆NT-pro BNP浓度从(53±11)pg/mL增加到(162±27)pg/mL(P<0.01)。对照组从(51±10)pg/mL增加到(194±38)pg/mL(P<0.01)。两组化疗前NT-pro BNP水平差异无统计学意义(P>0.05),而化疗后治疗组(L-CN组)患儿血浆NT-pro BNP水平较对照组低(P<0.05),治疗组治疗后血浆NT-pro BNP的改善情况优于对照组。两组化疗前后ECG及cTnI、LDH1、CPK-MB均无明显变化(P>0.05)。结论:在急性淋巴细胞白血病患儿应用DNR化疗时,NT-pro BNP可用于监测其对心脏的早期影响,左卡尼汀对NT-pro BNP的改善程度较对照组明显。

AIM：To explore the value of N-terminal pro-brain natriuretic peptide（NT-pro BNP） in diagnosing the myocardiopathy induced by daunorubicin（DNR）and the more effective cardiac-protection drugs by investigating the changes of the NT-pro BNP levels after administrating DNR in children with acute lymphocytic leukemia.METHODS：Twenty-two children with acute lymphocytic leukemia who treated with DNR containing vincristine,L-asparaginase,prednisone,were randomly divided into two groups.The therapy group received L-CN as the cardiac-protection drug and the control group without protecting heart drug during chemotherapy with DNR.The level of NT-pro BNP in plasma was measured by immunoassay before and after using DNR and the cardiac troponin I（cTnI） and cardiac muscle enzyme（LDH1,CPK-MB） and ECG were detected before and after chemotherapy.RESULTS：The level of NT-pro BNP in plasma was increased from（53±11） pg/mL to（162±27） pg/mL（P〈0.01） in the therapy group after chemotherapy and which in the control group was increased from（51±10） pg/mL to（194±38） pg/mL（P〈0.01）.There was no significant difference in the level of NT-pro BNP before chemotherapy between two groups.The level of NT-pro BNP in plasma was lower in the therapy group than that in the control group（P〈0.05）.The improving condition of the level of NT-pro BNP in the therapy group was better than that in the control group after chemotherapy.There were no significant difference in the ECG and cTnI and LDH1,CPK-MB in two groups before and after chemotherapy.CONCLUSION：NT-pro BNP can be served as a good indicator for DNR-induced myocardiopathy.Compared with control group,the improving condition of NT-pro BNP is obvious treated with levocarnitine.