强烈化疗对急性淋巴细胞白血病和非霍奇金淋巴瘤肾功能的影响

Intensive chemotherapy and renal damages in children with acute lymphoblastic leukemia and non-Hodgkin's lymphoma

目的 了解多中心协作化疗方案（MCP方案）对急性淋巴细胞白血病（ALL）和非霍奇金淋巴瘤（NHL）患儿肾脏功能的影响。方法 采用自身叶照法对序贯入院实施MCP化疗的ALL33例和NHL19例患儿肾功能进行多参数监测,包括血清BUN、Cr、Ccr、血、尿β2-MG、尿Alb、TRF、IgG、RBP等。结果 同化疗前比较,化疗后患者血BUN、Cr、Ccr大多正常,仅9例出现镜下血尿或轻度蛋白尿;血、尿β2-MG及尿Alb、RBP显著升高（P<0.05）,而尿TRF和IgG则无明显升高（P>0.05）。结论 MCP方案对ALL和NHL患儿的肾脏功能有一定程度的损害,以尿RBP舍量升高为主要标志的肾小管损害为主,但均处于亚临床状态;是否呈可逆性改变,有待于长期随访。

Objective To investigate the renal damages in children with acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL)who received the intensive multicenter-protocols (MCP). Methods 52 cases of consecutively diagnosed acute lymphoblastic leukemia (ALL,33 cases) and non-Hodgkin's lymphoma (NHL, 19 cases) were detected by multi-parameter assay including serum BUN,Cr,Ccr,β2-MG and urinary β2-MG, Alb.TRF, IgG.RBP. Results Corresponding to the pre-chemotherapy the levels of BUN,Cr,Ccr were normal in most children, microscopic hematuria or mild proteinuria were presented in 9 cases of children , blood β2-MG and urinary β2-MG, Alb,RBP increased significantly(P <0.05), whereas urinary TRF, IgG were elevated insignificantly ( P > 0.05). Conclusions Different degrees of renal damages with a predominance of tubular dysfunction, especially marked by alleviated urinary RBP,occurred in the patients receiving MCP, most of whom were in subclinical status. Whether it needs long -term follows-up whether it is irreversible.