Hoorweg-Nijman J J, Kardos G, Roos J C, van Dijk H J, Netelenbos C, Popp-Snijders C, de Ridder C M, Delemarre-van de Waal H A
Department of Paediatrics, Vrije Universiteit, Amsterdam, The Netherlands.
Clin Endocrinol (Oxf). 1999 Feb;50(2):237-44. doi: 10.1046/j.1365-2265.1999.00654.x.
In order to determine if a serious disease like childhood acute lymphoblastic leukaemia (ALL) and the treatment necessary to cure the patients has long term effects on bone mass, we assessed bone mineral density (BMD) and several parameters involved in bone formation in a group of young adult survivors of ALL.
Fourteen male and ten female survivors, treated for ALL in childhood, were cross-sectionally studied, at a mean age of 25.1 years (range 20.1-34.9). All patients, except for two, had received cranial irradiation as part of their treatment (mean radiation dose 2460 cGy).
Height and weight were measured. Bone mineral density (BMD) was assessed using dual energy X-ray absorptiometry in the lumbar spine, femoral neck, femoral trochanter and at 1/3 distal and ultradistal in the radius. Early morning serum levels of LH, FSH, oestradiol or testosterone, IGF-1 and IGF-BP3 were determined as well as several specific markers of bone turnover.
Mean height, expressed as standard deviation score (SDS) was -1.12, significantly reduced. BMD in the lumbar spine, femoral neck and at 1/3 distal and ultradistal in the radius, was significantly lower compared to the reference population (P < 0.05). No correlation was found between the BMD values and the cumulative dose of administered cytotoxic drugs, the age at diagnosis of ALL or the duration of follow-up. Mean IGF-1 and IGF-BP3 SDS-scores were -1.24 and -0.78 respectively, significantly reduced. GH stimulation tests performed in a subgroup of 9 patients showed an insufficient peak GH response in at least one test in all tested patients. The values of LH, FSH oestradiol or testosterone were within the normal adult range. Serum markers of bone formation and bone resorption were in the normal range, indicating that bone turnover was normal at the time of the study.
Bone development in patients cured of acute lymphoblastic leukaemia is disturbed, resulting in a significantly reduced bone mineral density. Impaired growth hormone activity, as a long term effect of cranial irradiation, may be one of the underlying causes as well as the illness itself and the administered cytotoxic drugs. Since a reduced bone mineral density predispose patients to osteoporosis, intervention in order to improve bone mass should be considered.
为了确定像儿童急性淋巴细胞白血病（ALL）这样的严重疾病以及治愈患者所需的治疗对骨量是否有长期影响，我们评估了一组ALL年轻成年幸存者的骨矿物质密度（BMD）以及参与骨形成的几个参数。
对14名男性和10名女性童年期接受ALL治疗的幸存者进行了横断面研究，平均年龄为25.1岁（范围20.1 - 34.9岁）。除两名患者外，所有患者均接受了头颅照射作为治疗的一部分（平均辐射剂量2460 cGy）。
测量身高和体重。使用双能X线吸收法评估腰椎、股骨颈、股骨大转子以及桡骨1/3远端和超远端的骨矿物质密度（BMD）。测定清晨血清促黄体生成素（LH）、促卵泡生成素（FSH）、雌二醇或睾酮、胰岛素样生长因子-1（IGF-1）和胰岛素样生长因子结合蛋白3（IGF-BP3）水平以及几种骨转换的特异性标志物。
以标准差评分（SDS）表示的平均身高为 -1.12，显著降低。腰椎、股骨颈以及桡骨1/3远端和超远端的BMD与参考人群相比显著降低（P < 0.05）。未发现BMD值与所给予细胞毒性药物的累积剂量、ALL诊断时的年龄或随访时间之间存在相关性。平均IGF-1和IGF-BP3的SDS评分分别为 -1.24和 -0.78，显著降低。在9名患者的亚组中进行的生长激素刺激试验显示，所有受试患者至少在一项试验中生长激素峰值反应不足。LH、FSH、雌二醇或睾酮的值在正常成人范围内。骨形成和骨吸收的血清标志物在正常范围内，表明在研究时骨转换正常。
急性淋巴细胞白血病治愈患者的骨骼发育受到干扰，导致骨矿物质密度显著降低。作为头颅照射的长期影响，生长激素活性受损可能是潜在原因之一，疾病本身和所给予的细胞毒性药物也是原因。由于骨矿物质密度降低使患者易患骨质疏松症，应考虑采取干预措施以改善骨量。
