Bebeshko V G, Bruslova K M, Pushkareva T I, Tsvietkova N M, Lyashenko L O, Sergeeva A S, Kuzmenko V F, Iatsemyrskiy S M, Samson Yu M, Boyarsky V G, Tryhlіb I V
State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», Melnykova str., 53, Kyiv, 04050, Ukraine.
Probl Radiac Med Radiobiol. 2017 Dec;22:306-315.
Determination of serum cortisol level in the initial period of acute leukemia in children, who exposed to ion izing radiation and other factors of Chornobyl accident, depending on their age and prognosis of disease.
The study involved 283 children residents of Kyiv, Zhytomyr and Chernihiv regions. There were 90 acute leukemia patients(AL) (ALL - 56, AML - 34), and 193 people of comparison group with anemia, leukemoid reactions and lymphadenopathy. We analyzed the type of comorbid somatic pathology, diseases in the genealogy, hematological parameters, cortisol levels in blood serum and irradiation doses in all children. In patients with AL expected median survival was calculated.
In 28.9 % of AL children the initial cortisol content was below 200 nmol/l, in 7.8 % - higher than 500 nmol/l (in the comparison group 10.4 % and 17.1 % respectively). Among AL patients with cortisol levels below 200 nmol/l were significantly less amount of persons with chronic bacterial infections and persistent viral infections (CMV, EBV) and in the genealogy of these children allergic reactions, endocrine pathology diagnosed more often compared with patients, whose hormone levels was higher than 200 nmol/l (p < 0.05). Distribution of children from control group by gradations of cortisol, age groups, defined somatic pathology and diseases in genealogy had no difference. It is shown, that lower initial blood serum cortisol level in ALL children correlates to a greater probability of relapse (Rs = -0,67). In patients with AML a direct correlation between cortisol level and median survival was detected (Rs = 0,79). Children radiation doses were ranging from 0.08 mSv to 14.9 mSv, and there were slightly higher among residents of Zhytomyr region (8.4 ± 1.2 mSv) compared to other regions. However, these doses did not affect blood serum cortisol levels in children and the course of AL.
These data suggest the need for correction and individualization of corticosteroid doses for optimization of AL patients treatment. Children, who have lower than normative serum cortisol levels are at increased risk of hema tologic pathology and they need for hematologic monitoring.
根据年龄和疾病预后，测定受切尔诺贝利事故电离辐射及其他因素影响的儿童急性白血病初期的血清皮质醇水平。
该研究纳入了基辅、日托米尔和切尔尼戈夫地区的283名儿童居民。其中有90例急性白血病患者（AL）（急性淋巴细胞白血病 - 56例，急性髓细胞白血病 - 34例），以及193名患有贫血、类白血病反应和淋巴结病的对照组人员。我们分析了所有儿童的合并躯体病理学类型、家族病史、血液学参数、血清皮质醇水平和辐射剂量。计算了AL患者的预期中位生存期。
在28.9%的AL儿童中，初始皮质醇含量低于200 nmol/l，7.8%高于500 nmol/l（对照组分别为10.4%和17.1%）。在皮质醇水平低于200 nmol/l的AL患者中，患有慢性细菌感染和持续性病毒感染（巨细胞病毒、EB病毒）的人数明显较少，与激素水平高于200 nmol/l的患者相比，这些儿童家族中过敏反应、内分泌病理学的诊断更为常见（p < 0.05）。对照组儿童按皮质醇分级、年龄组、确定的躯体病理学和家族病史分布无差异。结果表明，ALL儿童较低的初始血清皮质醇水平与更高的复发概率相关（Rs = -0.67）。在急性髓细胞白血病患者中，检测到皮质醇水平与中位生存期呈直接相关（Rs = 0.79）。儿童辐射剂量范围为0.08 mSv至14.9 mSv，日托米尔地区居民的辐射剂量（8.4 ± 1.2 mSv）略高于其他地区。然而，这些剂量并未影响儿童血清皮质醇水平和AL的病程。
这些数据表明需要对皮质类固醇剂量进行校正和个体化，以优化AL患者的治疗。血清皮质醇水平低于正常的儿童血液学病理风险增加，需要进行血液学监测。
