急性淋巴细胞白血病长期存活者的身体组成

Body composition of long-term survivors of acute lymphoblastic leukaemia.

作者信息

Warner Justin T, Evans William D, Webb David K H, Gregory John W

机构信息

Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.

出版信息

Med Pediatr Oncol. 2002 Mar;38(3):165-72. doi: 10.1002/mpo.1304.

DOI:10.1002/mpo.1304

PMID:11836715

Abstract

BACKGROUND

Long-term quality of life is of growing importance in children previously treated for malignancy. Obesity defined indirectly from indices of height and weight, has been described in long-term survivors of acute lymphoblastic leukaemia (ALL) and hypothesised to be a consequence of previous cranial irradiation.

PROCEDURE

In this study, measures of whole and regional body composition using skinfold and dual energy X-ray absorptiometry (DEXA) measurements have been made in 35 long-term survivors of ALL who had received cranial irradiation and chemotherapy. To assess the influence of cranial irradiation, results were compared with those obtained in 21 children treated for other malignancies, who received chemotherapy alone and with 31 healthy sibling controls.

RESULTS

Girls treated for ALL were significantly fatter than those treated for other malignancies or healthy control siblings whether measured by skinfold thickness (median (range) 37.4% (17.9-41.3) vs. 24.6% (19.1-35.0) and 28.8% (19.6-43.1), respectively, P<0.01) or DEXA (33.5% (20.5-42.8) vs. 25.5% (16.5-31.0) and 24.5% (18.8-53.6), respectively, P<0.01). Boys treated for ALL were not significantly fatter than boys in the other two groups. Measures of whole body percent fat derived from DEXA were persistently less than those derived from skinfold measurements with a mean (95% CI) difference of 2.4% (1.7-3.1, P<0.001) for all groups combined. In ALL survivors, using regression equations for skinfold thicknesses derived from controls with DEXA as the 'gold standard' method, fat mass was significantly overestimated.

CONCLUSION

Female survivors of ALL are significantly fatter than those of other malignancies and healthy sibling controls. Caution should be observed in the application of published equations, derived from the normal population, for the calculation of body composition in children treated for ALL. The mechanism of onset of obesity remains unclear, but is probably multifactorial and related to previous cranial irradiation.

摘要

背景

长期生活质量在曾接受恶性肿瘤治疗的儿童中愈发重要。通过身高和体重指数间接定义的肥胖，在急性淋巴细胞白血病（ALL）长期存活者中已有描述，并被认为是既往颅脑照射的结果。

方法

在本研究中，对35名接受过颅脑照射和化疗的ALL长期存活者，采用皮褶厚度测量和双能X线吸收法（DEXA）测量了全身及局部身体成分。为评估颅脑照射的影响，将结果与21名仅接受化疗的其他恶性肿瘤患儿及31名健康同胞对照的结果进行了比较。

结果

无论是通过皮褶厚度测量（中位数（范围）分别为37.4%（17.9 - 41.3）、24.6%（19.1 - 35.0）和28.8%（19.6 - 43.1），P<0.01）还是DEXA测量（分别为33.5%（20.5 - 42.8）、25.5%（16.5 - 31.0）和24.5%（18.8 - 53.6），P<0.01），接受ALL治疗的女孩都比接受其他恶性肿瘤治疗的女孩或健康对照同胞明显更胖。接受ALL治疗的男孩并不比其他两组男孩明显更胖。所有组综合来看，DEXA得出的全身脂肪百分比测量值持续低于皮褶厚度测量值，平均（95%可信区间）差异为2.4%（1.7 - 3.1，P<0.001）。在ALL存活者中，以DEXA作为“金标准”方法，使用从对照得出的皮褶厚度回归方程时，脂肪量被显著高估。