急性白血病儿童血脂、蛋白质和氨基酸代谢变化

Lipids,protein and amino acids metabolism of childhood acute leukemia

目的：探索儿童白血病的机体代谢变化。方法：对３０例急性白血病（ＡＬ）病儿在诊断时、２３例急性淋巴细胞性白血病（ＡＬＬ）病儿在化疗２周末和缓解后的血脂、蛋白质和氨基酸血清浓度作生化测定。结果：诊断时３０例ＡＬ病儿血清总胆固醇（ＴＣＨ）降低（Ｐ＜０．０５）、高密度脂蛋白（ＨＤＬ）降低（Ｐ＜０．０１），总甘油三酯（ＴＧ）升高（Ｐ＜０．０１）；血清白蛋白（Ａｌｂ）、前白蛋白（ＰＡ）降低（Ｐ均＜０．０１）。某些生糖氨基酸（ＧＡＡ）、支链氨基酸（ＢＣＡＡ）、谷氨酰胺－谷氨酸和牛磺酸（ＴＡＵ）降低（Ｐ均＜０．０１）。２３例ＡＬＬ病儿化疗２周末ＴＣＨ、ＴＧ下降（Ｐ分别＜０．０１和＜０．０５），Ａｌｂ下降、谷氨酰胺－谷氨酸升高（Ｐ均＜０．０１）；缓解后ＴＣＨ、ＨＤＬ升高，ＴＧ下降（Ｐ均＜０．０５），ＰＡ升高（Ｐ＜０．０１），血清氨基酸谱无明显变化。结论：急性白血病病儿对外源性脂肪利用能力降低，存在血清蛋白及ＧＡＡ、ＢＣＡＡ、谷氨酰胺（Ｇｌｎ）和ＴＡＵ缺乏。提示给予ＡＬ病儿营养支持时应用脂肪乳剂要慎重，应重视补充ＧＡＡ、ＢＣＡＡ、Ｇｌｎ和ＴＡＵ。

Objectives:To explore the metabolism of the childhood leukemia. Methods:Serum lipids,protein and amino acid profile were analyzed in 30 children with newly diagnosed acute leukemia(AL) and 23 children with acute lymphoblastic leukemia(ALL) undergoing induction. Results:In 30 children of newly diagnosed AL,total cholesterol(TCH)( P <0.05) and high density lipoprotein(HDL)( P <0.01) level were lower while total glycerol(TG) level was higher( P <0.01).Serum albumin(Alb),prealbumin(PA),glucogenic amino acid(GAA),branch chain amino acid(BCAA),glutamine(GLN) glutamic acid and taurine(TAU) were lower(All P <0.01) as well.After two week induction,TCH and TG decreased( P <0.01, P <0.05 respectively),Alb decreased and GLN glutamic acid increased (All P <0.01) in 23 children with ALL.Acquiring complete remission(CR),their serum lipids recovered but amino acid profile has no changes. Conclusions:Lipid emulsion should be deliberately administered and GAA,BCAA,GLN,TAU be supplied when nutrition support was performed on childhood AL.