Kuznetsova E I
Patol Fiziol Eksp Ter. 2014 Oct-Dec(4):71-7.
In children with lymphoid tumors (LT) chemotherapy is the main treatment. It is known, that many chemotherapy drugs have toxic effects on the central nervous system and is a factor, that leads to significant cognitive impairment. Purpose: Search of neurophysiological, neurochemical, and psychological correlates of neurotoxicity in children with LT when programmed therapy.
The study included 39 children (4-16 years) with LT, with acute lymphoblastic leukemia (ALL) - 25, with non-Hodgkin's lymphoma (NHL) - 14 who were treated according to the scheme m-BFM-90: for patients with ALL (mALL-BFM -90) and the NHL (mNHL - BFM-90). Investigated the EEG, REG, ECHO EG. In 12 children with LT in blood serum levels of middle molecules (MM) - indicator of general toxicity, N-acetylneuraminic acid (N-ANA) - indicator of neurotoxicity, malondialdehyde (MDA) - lipid peroxidation, tocopherol, retinol - indicators of antioxidant protection, level of catalase - as free radical oxida- lion; vanilmindalic acid levels (VMA) - as indicator of the state catecholaminergic system. Studies were performed before treatment, after induction of remission, after M-protocol, after the end of chemotherapy. In 23 children (11-16 years) with LT during chemotherapy, performed a comparison of EEG and the level of anxiety (Ch.D.Spilberger), <
The main results obtained in the present study were that 1) Prior to initiation of treatment of children with LT had a EEG changes, indicating certain dysfunction of diencephalic structures of the brain, and probably due to metabolic disorders that affect the neurotransmitter metabolism. 2) Toxic effects of chemotherapy on the CNS program was shown on a range of indicators: according to EEC-increasing values of relative power in the band δ- and Θ-frequency range, lower α-activity, increase of relative power in the band betal,2; according to REG-hemodynamic compromise; increasing levels of neurochemical indicators N-ANA and the VMA. This was accompanied by behavior strategies <
在患有淋巴肿瘤（LT）的儿童中，化疗是主要治疗方法。众所周知，许多化疗药物对中枢神经系统具有毒性作用，并且是导致严重认知障碍的一个因素。目的：在进行程序化治疗时，寻找LT患儿神经毒性的神经生理、神经化学和心理相关因素。
该研究纳入了39名4至16岁的LT患儿，其中急性淋巴细胞白血病（ALL）25例，非霍奇金淋巴瘤（NHL）14例，他们均按照m-BFM-90方案进行治疗：ALL患者采用mALL-BFM-90方案，NHL患者采用mNHL-BFM-90方案。对脑电图（EEG）、脑血流图（REG）、超声脑电图（ECHO EG）进行了检测。在12例LT患儿中，检测了血清中中分子（MM）水平（一般毒性指标）、N-乙酰神经氨酸（N-ANA）水平（神经毒性指标）、丙二醛（MDA）水平（脂质过氧化指标）、生育酚、视黄醇水平（抗氧化保护指标）以及过氧化氢酶水平（作为自由基氧化指标）；香草扁桃酸（VMA）水平（作为儿茶酚胺能系统状态指标）。在治疗前、诱导缓解后、M方案后以及化疗结束后进行了各项检测。在23例11至16岁的LT患儿化疗期间，对EEG与焦虑水平（Ch.D.Spilberger）、“策略选择行为”（Thomas-Kilman）进行了比较。对照组为同龄健康儿童。
本研究获得的主要结果如下：1）在LT患儿开始治疗前，EEG出现变化，表明大脑间脑结构存在一定功能障碍，可能是由于影响神经递质代谢的代谢紊乱所致。2）化疗对中枢神经系统的毒性作用在一系列指标上得以体现：根据EEG，δ频段和θ频段相对功率值增加，α活性降低，β1、2频段相对功率增加；根据REG，出现血流动力学受损；神经化学指标N-ANA和VMA水平升高。同时伴有“适应”和“合作”等行为策略，而这些并非健康同龄儿童所特有。确定了LT患儿化疗方案中神经毒性的个体预测指标。
