急性淋巴细胞白血病患儿血清sTNFRs水平测定的临床价值

The clinical value of serum soluble receptors for tumor necrosis factor in childhood acute lymphocytic leukemia

目的 :探讨急性淋巴细胞白血病患儿血清 TNFa、s TNFR- 和 s TNFR- 水平及其临床意义。方法 :采用 EL ISA法测定血清 TNFa、s TNFR- 和 s TNFR- 水平。结果 :2 4例 AL L患儿血清 TNFα〔(173.2 2±74.5 1) ng/L〕明显高于 2 0例正常对照儿童〔(78.5 9± 18.45 ) ng/L〕,初发与复发患儿血清 s TNFR- 〔(2 .76±1.0 5 )、(2 .44± 1.37) μg/L〕、s TNFR- 〔(2 .33± 1.18)、(2 .0 9± 1.2 2 ) μg/L〕明显高于正常儿童〔(0 .75± 0 .2 6 )、(0 .71± 0 .14) μg/L〕,均为 P <0 .0 1;血清 TNFα与 s TNFR- 呈显著性正相关 (r =0 .6 31,P <0 .0 1) ;8例患儿经有效治疗完全缓解后血清 s TNFRs均降至正常水平〔(0 .83± 0 .2 5 )、(0 .92± 0 .17) μg/L〕;血清 s TNFRs在WBC≥ 10 0× 10 9/L患儿的阳性率明显高于 WBC<10 0× 10 9/L者 (P <0 .0 1) ,其与外周血幼稚细胞数呈显著正相关 (R =0 .72 4 ,R =0 .582 ,P <0 .0 5)。结论 :AL L患儿血清 s TNFRs异常升高与白血病细胞有关 ,血清 s TNFRs水平可作为估计肿瘤负荷及治疗效果的一项指标。

Objective:To investigate the clinical value of serum soluble receptors for tumor necrosis factor in childhood acute lymphocytic leukemia (ALL).Methods:Serum tumor necrosis factor (TNFα), serum soluble tumor necrosis factor receptor I (sTNFR I) and soluble tumor necrosis factor receptor Ⅱ (sTNFR Ⅱ) were detected with enzyme link immunosorbent assay in 24 ALL and 20 health children.Results:The serum TNFα level in ALL children 〔( 173.22 ± 74.51 ) ng/L)〕 was remarkably higher than normal control 〔( 78.59 ± 18.45 ) ng/L〕. The serum sTNFR I 〔( 2.76 ± 1.05 ), ( 2.44 ± 1.37 ) μg/L〕 and sTNFR II 〔( 2.33 ± 1.18 ),( 2.09 ± 1.22 )μg/L〕 levels in incipient and recurrent patients were significantly increased compared with normal control group 〔( 0.75 ± 0.26 ), ( 0.71 ± 0.14 ) μg/L〕. There was a remarkably positive relationship between serum TNFa and sTNFR I levels (r= 0.631 ,P< 0.01 ). In 8 cases of complete remission (CR) patients, serum sTNFRs levels were decreased all to normal 〔( 0.83 ± 0.25 ), ( 0.92 ± 0.17 ) μg/L respectively〕. High levels of serum sTNFRs were more common in patients with high leukocyte count (≥100×10 9/L) and positively correlated with peripheral blood blasts (R Ⅰ= 0.724 , R Ⅱ= 0.582 , respectively, P< 0.05 ).Conclusion:The enhanced serum sTNFRs levels in ALL children might have relation to leukemic cells and are an index of predicting prognosis.