Nevruz Oral, Yokusoglu Mehmet, Uzun Mehmet, Demirkol Sait, Avcu Ferit, Baysan Oben, Koz Cem, Cetin Türker, Sag Cemal, Ural Ali Ugur, Isik Ersoy
Department of Hematology, Gulhane Military Medical School, Ankara, Turkey.
Tohoku J Exp Med. 2007 Feb;211(2):121-6. doi: 10.1620/tjem.211.121.
Acute leukemia is one of the leading malignancies worldwide. Although neuropathy was reported as one of the complications of leukemia, there is a little data about the autonomic involvement. This study was designed to investigate the cardiac autonomic disturbances in acute leukemias by using time-domain indices of heart rate variability (HRV). Newly diagnosed 36 patients with acute leukemia (14 acute lymphoblastic leukemia and 22 acute myeloblastic leukemia) and gender- and age-matched 32 healthy subjects as controls were enrolled in this study. The diagnosis of leukemia was established by whole blood count, peripheral smears and bone marrow aspirations. In order to rule out the effect of any medication on HRV, the patients were selected from those who had not received any antineoplastic agent yet. For assessing the cardiac autonomic functions, HRV obtained from 24-hr Holter monitor recordings was used. The age, gender and serum ferritin levels were similar, while hemoglobin levels were lower in the leukemia group. The comparison of the leukemia group and control group revealed that HRV decreased in patients with acute leukemia, which reflects sympathetic dominance in acute leukemia. This is the first study that shows altered cardiac autonomic functions in patients with acute leukemias who are not on any therapeutical intervention. The altered cardiac autonomic functions may be a sign of paraneoplastic neuropathy in patients with acute leukemia.
急性白血病是全球主要的恶性肿瘤之一。尽管神经病变被报道为白血病的并发症之一，但关于自主神经受累的资料却很少。本研究旨在通过使用心率变异性（HRV）的时域指标来调查急性白血病患者的心脏自主神经功能紊乱情况。本研究纳入了36例新诊断的急性白血病患者（14例急性淋巴细胞白血病和22例急性髓细胞白血病）以及32例年龄和性别匹配的健康受试者作为对照。白血病的诊断通过全血细胞计数、外周血涂片和骨髓穿刺来确定。为了排除任何药物对HRV的影响，患者选自尚未接受任何抗肿瘤药物治疗的人群。为了评估心脏自主神经功能，使用了从24小时动态心电图监测记录中获得的HRV。两组在年龄、性别和血清铁蛋白水平方面相似，但白血病组的血红蛋白水平较低。白血病组与对照组的比较显示，急性白血病患者的HRV降低，这反映了急性白血病患者交感神经占优势。这是第一项表明未接受任何治疗干预的急性白血病患者心脏自主神经功能改变的研究。心脏自主神经功能的改变可能是急性白血病患者副肿瘤性神经病变的一个迹象。
