Cetingül N, Aydinok Y, Kantar M, Oniz H, Kavakli K, Yalman O, Erermiş S, Celebisoy N, Akyürekli O, Oztop S, Nişli G
Ege University, Faculty of Medicine, Department of Paediatrics, Izmir, Turkey.
Pediatr Hematol Oncol. 1999 May-Jun;16(3):213-20. doi: 10.1080/088800199277263.
The neurotoxicity of either systemic chemotherapy or central nervous system prophylaxis was studied in 19 children treated for acute lymphoblastic leukemia (ALL). They had completed ALL therapy at least a year before and survived more than 5 years after diagnosis. The duration between age at diagnosis and age at investigation was 8.6 +/- 2.7 years (5-15 years). Neuropsychologic tests, cranial magnetic resonance imaging (MRI), and evoked potentials (EP) were studied. Seventeen healthy siblings were taken as a control group. Emotional evaluation was done using the childhood depression inventory and Beck depression inventory. Cognitive functions were evaluated using Wechsler's Intelligence Scale for Children-Revised (WISC-R) or the Wechsler's Adult Intelligence Scale-Revised (WAIS-R) tests, which were adapted to Turkish children. Performance and total IQ scores (94.0 +/- 16.8 and 92.2 +/- 16.5) were significantly low as compared to the control group (112.1 +/- 18.9 and 105.4 +/- 14.2) (p = .007 and p = .02). Abnormal MRI findings were found in 33.3% (6/18). Three out of 18 patients (16.6%) had abnormal auditory while 5 out of 17 patients (29.5%) displayed abnormal visual EPs. Abnormal findings in MRI, cognitive examination, and electrophysiologic testing were not associated with age at diagnosis, radiotherapy doses, intermediate/high-dose systemic methotrexate administration or central nervous system involvement. But more patients must be studied to demonstrate discrete outcomes of neurotoxicity in long-term survivors of childhood leukemia.
对19名接受急性淋巴细胞白血病（ALL）治疗的儿童进行了全身化疗或中枢神经系统预防的神经毒性研究。他们至少在一年前完成了ALL治疗，诊断后存活超过5年。诊断时年龄与调查时年龄之间的间隔为8.6±2.7岁（5 - 15岁）。研究了神经心理学测试、头颅磁共振成像（MRI）和诱发电位（EP）。选取17名健康的兄弟姐妹作为对照组。使用儿童抑郁量表和贝克抑郁量表进行情绪评估。使用韦氏儿童智力量表修订版（WISC - R）或韦氏成人智力量表修订版（WAIS - R）测试对认知功能进行评估，这些测试已针对土耳其儿童进行了调整。与对照组（112.1±18.9和105.4±14.2）相比，表现智商和总智商分数（94.0±16.8和92.2±16.5）显著较低（p = .007和p = .02）。33.3%（6/18）的患者MRI检查结果异常。18名患者中有3名（16.6%）听觉诱发电位异常，17名患者中有5名（29.5%）视觉诱发电位异常。MRI、认知检查和电生理测试中的异常结果与诊断时年龄、放疗剂量、中/高剂量全身甲氨蝶呤给药或中枢神经系统受累无关。但必须研究更多患者以证明儿童白血病长期幸存者神经毒性的具体结果。
