-
白血病患者血脂异常以及化疗对其影响在国内报道不多, 结论也不一致[1]。Pui等[2]研究表明: 血液系统的恶性肿瘤至少有一项血脂指标异常, 且血脂异常随病情转归而发生改变, 血清β2-微球蛋白(β2-microglolulin, β2-MG)和肿瘤坏死因子α(tumor necrosis factor-α, TNF-α)水平较正常显著增高。为此, 我们对123例急性白血病患者的血脂、β2-MG及TNF-α水平变化进行了研究, 结果报道如下。
-
123例急性白血病患者的血脂分析、血清TG较36名对照者明显增高(t=4.123~6.815, P均 < 0.01), 血清脂蛋白(α)均轻度增高(t=1.345, t=1.421, t=1.381, P < 0.05), 血清胆固醇、HDL-C、LDL-C、APOA均降低(t=2.110~2.574, P < 0.05), 而血清APOB均轻度降低(t=1.261, t=1.381, t=1.456, P > 0.05)。具体结果见表 1。急性白血病患者血清β2-MG(t=6.316, t= 6.815, t=5.818, P < 0.01)和TNF-α(t=4.134, t=4.457, t= 4.256, P < 0.01)水平较正常对照者均明显增高(表 2)。
n TG
(mmol/L)胆固醇
(mmol/L)HDL-C
(mmol/L)LDL-C
(mmol/)LAPOA
(g/L)APOB
(g/L)脂蛋白(α)
w对照组 36 1.68 ±0.36 4.12 ±0.98 1.20 ±0.28 2.95 ±0.51 1.18±0.19 0.85 ±0.36 0.22 ±0.12 AML组 46 2.19 ±0.58 3.61 ±1.13 0.71 ±0.24 2, 41 ±0.73 0.76 ±0.20 0.83 ±0.21 0.24 ±0.21 ALL组 32 2.16 ±0.71 3.44 ±0.84 0.85 ±0.31 2.52 ±0.68 0.78 ±0.25 0.82 ±0.18 0.27 ±0.22 ANLL组 45 2_31±0‘68 2.89 ±0.99 0.70 ±0.25 2.38 ±0.86 0J3±0, 26 0.78 ±0.25 0.26 ±0.23 注: 表中,TG: 三酰基甘油; HDL-C: 高密度脂蛋白-胆固醇; LDL-C: 低密度脂蛋白-胆固醇; APOA: 载脂蛋白入; APOB: 载脂蛋白B; AML: 急性单核细胞白血病; ALL: 急性淋巴细胞白血病; ANLL: 急性非淋巴细胞白血病。 表 1 急性白血病患者和正常对照组血脂分析的比较(x±s)
组别 例数 β2-微球蛋白(μg/L) 肿瘤坏死因子α(ng/L) 对照组 36 0.92土0.27 0.96 ±0.26 AML组 46 6.92 ± 3.24 2.41 ±0.68 ALL组 32 7.01 ±3.11 2.58 ±0.71 ANLL组 45 6.44 ±4.15 2.55 ±0.65 注: 表中,AML: 急性单核细胞白血病; ALL: 急性淋巴细胞白血病; ANLL: 急性非淋巴细胞白血病。 表 2 急性白血病患者血清β2-微球蛋白和肿瘤坏死因子α水平的比较(x±s)
急性白血病患者血脂、β2-微球蛋白及肿瘤坏死因子α水平测定的临床意义
Clinical value of blood lipid, serumβ2-microglolulin and tumor necrosis factor-α level in patients with acute leukemia
-
摘要:
目的 探讨血脂、β2-微球蛋白(β2-MG)和肿瘤坏死因子α(TNF-α)对急性白血病诊断的临床意义。 方法 采用放射免疫分析法测定血清中β2-MG和TNF-α的水平,生化法进行血脂分析,进行相关性检验。 结果 123例急性白血病患者中包括46例急性单核细胞白血病、32例急性淋巴细胞白血病和45例急性非淋巴细胞白血病。患者血脂、血清β2-MG和TNF-α水平与36名正常对照者比较:三酰基甘油、β2-MG和TNF-α均增高(t=4.123~6.815, P均 < 0.01),血清脂蛋白(α)轻度增高但无明显差异(t=1.345,t=1.421, t=1.381, P > 0.05),胆固醇、高密度脂蛋白-胆固醇、低密度脂蛋白-胆固醇、载脂蛋白A均降低(t=2.110~2.574, P < 0.05),载脂蛋白B轻度降低但无明显差异(t= 1.261, t=1.381, t=1.456, P > 0.05)。 结论 急性白血病的血脂、血清β2-MG和TNF-α水平的测定有助于疾病的诊断。 Abstract:Objective To study on diagnosis value of blood lipid, serum β2-microglolulin(β2-MG)and tumor necrosis factor-α(TNF-α)in acute leukemia. Methods The serum β2-MG and TNF-α(with radioimmunoassay)blood lipid(with biochemistry)levels were determined in 123 patients with acute leukemia as well as 36 controls, then conducted the correlative tests. Results Serum β2-MG、TNF-α and triglyceride levels in 123 patients including 46 patients with acute monocytic leukemia, 32 patients with acute lymphocytic leukemia and 45 patients with acute nonlymphocytic leukemia were significantly higher than those in 36 controls(t=4.123-6.815, P < 0.01).The serum lipoprotein(α)level was tightly increased(t=1.345, t=1.421, t=1.381, P > 0.05); The serum cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, apolipoprotein A levels in 123 patients with acute leukemia were significantly lower than those in 36 controls(t=2.110-2.574, P < 0.05), the serum apolipoprotein B level was tightly lowed(t=1.261, t=1.381, t=1.456, P > 0.05). Conclusion The determination of blood lipid, serum β2-MG and TNF-α level might be useful for diagnosing acute leukemia and reflecting the prognostic value. -
Key words:
- Leukemia /
- Beta 2-microglolulin /
- Tumor necrosis factor-alpha /
- Lipoproteins /
- Apolipoproteins /
-
-
表 1 急性白血病患者和正常对照组血脂分析的比较(x±s)
n TG
(mmol/L)胆固醇
(mmol/L)HDL-C
(mmol/L)LDL-C
(mmol/)LAPOA
(g/L)APOB
(g/L)脂蛋白(α)
w对照组 36 1.68 ±0.36 4.12 ±0.98 1.20 ±0.28 2.95 ±0.51 1.18±0.19 0.85 ±0.36 0.22 ±0.12 AML组 46 2.19 ±0.58 3.61 ±1.13 0.71 ±0.24 2, 41 ±0.73 0.76 ±0.20 0.83 ±0.21 0.24 ±0.21 ALL组 32 2.16 ±0.71 3.44 ±0.84 0.85 ±0.31 2.52 ±0.68 0.78 ±0.25 0.82 ±0.18 0.27 ±0.22 ANLL组 45 2_31±0‘68 2.89 ±0.99 0.70 ±0.25 2.38 ±0.86 0J3±0, 26 0.78 ±0.25 0.26 ±0.23 注: 表中,TG: 三酰基甘油; HDL-C: 高密度脂蛋白-胆固醇; LDL-C: 低密度脂蛋白-胆固醇; APOA: 载脂蛋白入; APOB: 载脂蛋白B; AML: 急性单核细胞白血病; ALL: 急性淋巴细胞白血病; ANLL: 急性非淋巴细胞白血病。 表 2 急性白血病患者血清β2-微球蛋白和肿瘤坏死因子α水平的比较(x±s)
组别 例数 β2-微球蛋白(μg/L) 肿瘤坏死因子α(ng/L) 对照组 36 0.92土0.27 0.96 ±0.26 AML组 46 6.92 ± 3.24 2.41 ±0.68 ALL组 32 7.01 ±3.11 2.58 ±0.71 ANLL组 45 6.44 ±4.15 2.55 ±0.65 注: 表中,AML: 急性单核细胞白血病; ALL: 急性淋巴细胞白血病; ANLL: 急性非淋巴细胞白血病。 -
[1] 张之南, 单澜东. 协和血液学. 北京: 中国协和医科大学出版社, 2004: 376-377.
[2] Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med, 2006, 354(2): 166-178. doi: 10.1056/NEJMra052603 [3] 张之南, 沈悌. 血液病诊断及疗效标准. 2版. 北京: 科学出版社, 1998: 171-186.
[4] Thomas DA, Faderl S, Cortes J, et al. Treatment of philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood, 2004, 103(12): 4396-4407. doi: 10.1182/blood-2003-08-2958 [5] Jurisicy V, Kraguljac N, Konjevic G, et al. TNF-alpha induced change in cell membrane antigen expression on K-562 cells associated with increased lactate dehydrogenase(LDH)release. Neoplasma, 2005, 52(1): 25-31. [6] Tramèr MR, Carroll D, Campbell FA, et al. Cannadinoids for control of chemotherapy induced nausea and vomiting quantitative systematic review. BMJ, 2001, 323(7303): 16-21. doi: 10.1136/bmj.323.7303.16 [7] Ottmann OG, Wasssman B, Pfeifer H, et al. lmatinib compared with chemotherapy as frint-line treatment of elderly patients with philadelphia chromosome-positive acute lymphoblastic leukemia(ph+ALL). Cancer, 2007, 109(10): 2068-2076. doi: 10.1002/cncr.22631 [8] Tallman MS, Kim HT, Paietta E, et al. Acute monocytic leukemia(French-American-British classification M5)does not have a worse prognosis than other subtypes of acute myeloid leukemia: a report from the Eastern Cooperative Oncology Group. J Clin Oncol, 2004, 22(7): 1276-86. doi: 10.1200/JCO.2004.08.060