Ludwig R, Kretzmann R, Burger R, Brandeis W E
Klin Wochenschr. 1987 Jan 15;65(2):76-81. doi: 10.1007/BF01745478.
The blood-CSF barrier inhibits permeation of most chemotherapeutic agents into the central nervous system (CNS). The influence of systemic chemotherapy and prohylactic CNS irradiation on the permeability of the blood-CSF barrier was studied in 49 children treated for acute lymphoblastic leukemia (ALL) or non-Hodgkin's lymphoma. To study the permeability of the blood-CSF barrier under treatment according to BFM-ALL protocols, nephelometric determinations of albumin, immunoglobulin G (IgG), and alpha-2-macroglobulin in serum and CSF and total protein in CSF were performed at several time intervals during chemotherapy and prophylactic cranial irradiation. During systemic induction chemotherapy, no significant changes of blood-CSF barrier could be observed. In contrast, in the course of prophylactic CNS irradiation and intrathecal methotrexate application, a significant elevation of albumin, alpha-2-macroglobulin and total protein in CSF, and a significant decrease of blood:CSF ratios for albumin and alpha-2-macroglobulin were observed. IgG did not change significantly. After prophylactic CNS treatment and during maintenance chemotherapy protein concentrations and blood:CSF ratios gradually returned to normal range. This normalization was accelerated by cortisone treatment during the reinduction period.
血脑屏障会抑制大多数化疗药物进入中枢神经系统（CNS）。在49例接受急性淋巴细胞白血病（ALL）或非霍奇金淋巴瘤治疗的儿童中，研究了全身化疗和预防性中枢神经系统放疗对血脑屏障通透性的影响。为了按照BFM-ALL方案研究治疗期间血脑屏障的通透性，在化疗和预防性颅脑照射的几个时间间隔，对血清和脑脊液中的白蛋白、免疫球蛋白G（IgG）和α-2-巨球蛋白进行比浊测定，并测定脑脊液中的总蛋白。在全身诱导化疗期间，未观察到血脑屏障有明显变化。相比之下，在预防性中枢神经系统照射和鞘内应用甲氨蝶呤的过程中，观察到脑脊液中白蛋白、α-2-巨球蛋白和总蛋白显著升高，白蛋白和α-2-巨球蛋白的血脑脊液比值显著降低。IgG没有明显变化。预防性中枢神经系统治疗后及维持化疗期间，蛋白质浓度和血脑脊液比值逐渐恢复到正常范围。再诱导期使用可的松治疗可加速这种恢复正常的过程。
