Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA. kevin.
Leuk Lymphoma. 2013 Mar;54(3):535-40. doi: 10.3109/10428194.2012.717080. Epub 2012 Aug 30.
Long-term survivors of childhood leukemia are at risk for neurocognitive impairment, although the neurophysiological basis is not well understood. The purpose of this study was to explore associations between changes in cerebrospinal fluid (CSF) phospholipids and neurocognitive function in children undergoing chemotherapy for acute lymphoblastic leukemia. Seventy-six children were followed prospectively from diagnosis. CSF samples were collected during scheduled lumbar punctures and phospholipids were extracted. Neurocognitive evaluations were conducted annually beginning shortly after diagnosis. Concentrations of sphingomyelin (SM) increased following induction (p = 0.03) and consolidation (p = 0.04), while lysophosphatidylcholine (LPC) increased following induction (p = 0.003). Multivariable analyses demonstrated associations between post-induction SM and motor speed at 1 year (p < 0.001), 2 years (p = 0.001) and 3 years (p = 0.02) following diagnosis. Post-induction LPC was associated with verbal working memory (p = 0.007). Results indicate that early changes in phospholipids are related to neurocognitive decline and suggest a chemotherapy impact on white matter integrity.
儿童期白血病幸存者存在神经认知障碍风险，尽管其神经生理学基础尚未完全明确。本研究旨在探讨急性淋巴细胞白血病患儿化疗过程中脑脊液（CSF）磷脂变化与神经认知功能之间的关联。76 名患儿前瞻性随访至诊断。在计划进行的腰椎穿刺期间采集 CSF 样本并提取磷脂。在诊断后不久，每年进行一次神经认知评估。诱导期后鞘磷脂（SM）浓度增加（p = 0.03），巩固期后增加（p = 0.04），而溶血磷脂酰胆碱（LPC）在诱导期后增加（p = 0.003）。多变量分析表明，诱导后 SM 与诊断后 1 年（p < 0.001）、2 年（p = 0.001）和 3 年（p = 0.02）的运动速度有关。诱导后 LPC 与言语工作记忆相关（p = 0.007）。结果表明，磷脂的早期变化与神经认知能力下降有关，提示化疗可能对大脑白质完整性产生影响。
