Karakurt Hasan, Sarper Nazan, Kılıç Suar Çakı, Gelen Sema Aylan, Zengin Emine
Department of Pediatrics, Division of Pediatric Hematology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
Pediatr Hematol Oncol. 2012 Sep;29(6):551-61. doi: 10.3109/08880018.2012.708892.
Acute lymphoblastic leukemia (ALL) survivors were screened for risk factors of cardiovascular disease. Forty-four ALL survivors in first remission were enrolled. Twenty-six also received 12-18 Gy cranial radiotherapy (RT). Patients' body mass indexes (BMIs) at dignosis and during the study were compared. Metabolic syndrome (MS) evaluation was performed in patients, parents, and siblings older than 6 years. Homeostasis Model Assessment (HOMA) index of the survivors was also calculated. In survivors with impaired fasting glucose levels, oral glucose tolerance test (OGTT) was performed. Thyroid functions and IGF-1 and/or IGFBP-3 levels of the survivors who received cranial RT were evaluated. Median age of the survivors was 11.5 years (6-23). At diagnosis, mean BMI percentile was 46.7 (3-95) and mean z-score was -0.09 ± 1.14; during the study, these values rose to 71.1 ± 25.6 (3-100) and 0.8 ± 0.94, respectively (P < .001). One patient (2.2%) and nine survivors (20%) were obese at diagnosis and during the study, respectively (P = .005). Survivors had significantly higher BMI percentile and BMI z-score compared to their siblings (P = .006 and P = .011, respectively). The study group was small and we could not show a correlation of the patients' obesity with RT, thyroid functions, IGF-1, and IGFBP-3 levels. In three survivors (6.8%), there was MS. Maternal and paternal MS was not found as a risk factor for MS of the survivors (P = .1, P = .5, respectively). The HOMA index revealed insulin resistance (IR) in 12 (27.2%) of the survivors, whereas OGTT revealed abnormal glucose regulation and/or IR in four. As a conclusion, ALL survivors have high risk for obesity and MS.
对急性淋巴细胞白血病（ALL）幸存者进行心血管疾病风险因素筛查。纳入44例首次缓解期的ALL幸存者。其中26例还接受了12 - 18 Gy的颅脑放疗（RT）。比较患者诊断时及研究期间的体重指数（BMI）。对患者、父母及6岁以上的兄弟姐妹进行代谢综合征（MS）评估。还计算了幸存者的稳态模型评估（HOMA）指数。对空腹血糖水平受损的幸存者进行口服葡萄糖耐量试验（OGTT）。评估接受颅脑放疗的幸存者的甲状腺功能以及胰岛素样生长因子-1（IGF-1）和/或胰岛素样生长因子结合蛋白-3（IGFBP-3）水平。幸存者的中位年龄为11.5岁（6 - 23岁）。诊断时，平均BMI百分位数为46.7（3 - 95），平均z值为 - 0.09±1.14；研究期间，这些值分别升至71.1±25.6（3 - 100）和0.8±0.94（P <.001）。诊断时1例患者（2.2%）肥胖，研究期间9例幸存者（20%）肥胖（P =.005）。与他们的兄弟姐妹相比，幸存者的BMI百分位数和BMI z值显著更高（分别为P =.006和P =.011）。研究组规模较小，我们未能显示患者肥胖与放疗、甲状腺功能、IGF-1和IGFBP-3水平之间的相关性。3例幸存者（6.8%）存在MS。未发现母亲和父亲的MS是幸存者MS的风险因素（分别为P =.1，P =.5）。HOMA指数显示12例（27.2%）幸存者存在胰岛素抵抗（IR），而OGTT显示4例存在葡萄糖调节异常和/或IR。总之，ALL幸存者肥胖和MS风险较高。
