Korinthenberg R, Ullrich K, Ritter J, Stephani U
Department of Pediatrics, University Hospital, Mannheim, Federal Republic of Germany.
Acta Paediatr Scand. 1990 Mar;79(3):335-42. doi: 10.1111/j.1651-2227.1990.tb11466.x.
We performed analyses of electrolytes, amino acids, albumin, alpha 2-macroglobulin, gamma-globulin and LDH in the lumbar cerebrospinal fluid of children undergoing treatment for acute lymphoblastic leukemia, non-Hodgkin-lymphoma or acute myeloid leukemia. At the time of diagnosis signs of a disturbance of the blood-brain barrier were found in some patients. During induction treatment with L-asparaginase a rise of glutamic acid and a decrease of glutamine occurred. This finding correlated with slowing of the EEG. Treatment with vincristine was associated with a slight drop of sodium and chloride concentration in serum, but not in the cerebrospinal fluid. Central nervous system prophylaxis with cranial irradiation, and to a lesser degree with intravenous medium-dose methotrexate, gave rise to a further deterioration of the blood-brain barrier function as indicated by an increase in albumin, alpha 2-macroglobulin and LDH levels. During radiotherapy the concentration of several amino acids rose, probably due to a disturbance of active carrier mechanisms. Patients with elevated albumin at the end of radiotherapy more often suffered an early leukemia relapse while still on treatment. No other clinical or electroencephalographic correlations of altered barrier function could be found.
我们对正在接受急性淋巴细胞白血病、非霍奇金淋巴瘤或急性髓细胞白血病治疗的儿童腰椎脑脊液中的电解质、氨基酸、白蛋白、α2-巨球蛋白、γ-球蛋白和乳酸脱氢酶进行了分析。在诊断时，发现部分患者存在血脑屏障紊乱的迹象。在用L-天冬酰胺酶进行诱导治疗期间，谷氨酸水平升高，谷氨酰胺水平降低。这一发现与脑电图减慢相关。长春新碱治疗与血清中钠和氯浓度略有下降有关，但脑脊液中无此现象。头颅照射进行中枢神经系统预防，以及程度较轻的静脉注射中剂量甲氨蝶呤，导致血脑屏障功能进一步恶化，表现为白蛋白、α2-巨球蛋白和乳酸脱氢酶水平升高。放疗期间，几种氨基酸的浓度升高，可能是由于活性载体机制紊乱所致。放疗结束时白蛋白升高的患者在仍在接受治疗时更常早期白血病复发。未发现屏障功能改变与其他临床或脑电图之间的相关性。
