果糖二磷酸钠对柔红霉素诱导的急性白血病患儿血浆脑钠素浓度的影响

Effects of fructose sodium diphosphate on the plasma brain natriuretic peptide levels in children with acute leukemia treated by daunorubicin

目的:通过观察急性白血病患儿应用柔红霉素(DNR)化疗后其血浆脑钠素(BNP)水平的改变及应用不同心肌保护药后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的指标.方法:选择2004/2008年新诊断的急性白血病患儿31例,均采用DNR+长春新碱+左旋门冬酰胺酶+泼尼松(DVLP)方案诱导化疗,化疗期间分别使用果糖二磷酸钠(实验组)或参麦注射液(对照组)保护心肌.在应用DNR前后用酶联免疫吸附试验测定患儿血浆BNP水平,并同时常规检测患儿化疗前后心肌酶谱(LDH1,CPK-MB)及心电图(ECG).结果:实验组患儿化疗后血浆BNP浓度从(3.89±1.43)ng/L增加到(15.12±4.38)ng/L(P<0.001).对照组从(3.72±1.38)ng/L增加到(18.45±5.29)ng/L(P<0.001).两组化疗前BNP水平无显著差异(P>0.05),而化疗后FDP组患儿血浆BNP水平较对照组低(P<0.001).两组化疗前后ECG及LDH1,CPK-MB均无明显变化.结论:在急性白血病患儿应用DNR化疗时,BNP可用于监测DNR对心脏的早期影响和判断心肌保护药的效果.

AIM：To explore the value of brain natriuretic peptide（BNP）in diagnosing the myocardiopathy induced by daunorubicin（DNR）and the more effective cardiac-protection drugs by investigating the changes of the BNP levels after adminis trating DNR in children with acute leukemia.METHODS：Thirty-one children with acute leukemia treated with a daunorubicin（DNR）-containing regimen were randomly divide into 2 groups.Experimental group received FDP as the cardiac-protection drug and Shenmai injection was used in control group during chemotherapy with DNR.Plasma BNP concentrations was measured by enzyme linked immunosorbent assay（ELISA）and ECG and cardiac muscle enzyme（LDH1,CPK-MB）were performed before and after administrating DNR routinly.RESULTS：The plasma BNP concentrations increased from（3.89±1.43）ng/L to（15.12±4.38）ng/L（P〈0.001）in experiment group and increased from（3.72±1.38）ng/L to（18.45±5.29）ng/L（P〈0.001）in control group after treated with DNR.There was no significant difference between two groups before chemotherapy（P〉0.05）and a significant difference after chemotherapy（P〈0.001）.The plasma BNP concentrations was lower in experiment group than in control group（P〈0.001）.However,ECG and cardiac muscle enzymes（LDH1,CPK-MB）had no significant difference in all children with acute leukemia.CONCLUSION：BNP can be served as a good indicator for DNR-induced myocardiopathy and maybe FDP is more effective than shenmai in protecting heart during chemotherapy with DNR.