Raluca Maniu Diana, Blag Cristina, Popa Gheorghe, Bota Madalina, Vlad Catalin, Cainap Calin, Balacescu Ovidiu, Pop Laura, Cainap Simona Sorana
Emergency County Hospital for Children, Pediatric Clinic no 2, Department of Pediatric Cardiology, Cluj-Napoca, Romania.
J BUON. 2018 Dec;23(7):122-131.
To describe the high-risk profile group, susceptible to develop anthracycline-induced cardiomyopathy in children with acute leukemia.
The study involved 35 pediatric patients diagnosed with acute lymphoblastic (ALL) or acute myeloblastic leukemia (AML), from March 2014 to December 2016. Serologic markers used for the analysis of cardiac dysfunction were troponin T, NT-proBNP and PCRhs. Also, the patients have had echocardiographic evaluation at the beginning of treatment to determine LVEF, SF and A, E, E' Doppler waves.
Positive linear correlation was shown between NT-proBNP and leukocyte values, NT-proBNP and blast cells value, and NT-proBNP and LDH. Significant linear negative correlations between LVEF with leukocyte values, blast cells values, LDH, SF and leukocyte values, LVEF and NT-proBNP values and LVEF and troponin T values were also identified. A weak negative correlation between E/E' ratio and blast cells values has been observed. All of these correlations were statistically significant (p<0.05).
Leukocyte value, as well as the other serological markers assessed (NT-proBNP, Troponin T), are useful tools to evaluate the risk of anthracycline-induced cardiotoxicity. The variation of the biological markers at the beginning of the cytotoxic treatment confirms the presence of an early myocardial dysfunction, emphasizing the importance of systematic evaluation of this particular group of patients.
描述急性白血病患儿中易发生蒽环类药物诱导性心肌病的高危人群特征。
该研究纳入了2014年3月至2016年12月期间诊断为急性淋巴细胞白血病（ALL）或急性髓细胞白血病（AML）的35例儿科患者。用于分析心脏功能障碍的血清学标志物为肌钙蛋白T、N末端脑钠肽前体（NT-proBNP）和高敏C反应蛋白（PCRhs）。此外，患者在治疗开始时进行了超声心动图评估，以确定左心室射血分数（LVEF）、缩短分数（SF）以及A、E、E' 多普勒波。
NT-proBNP与白细胞值、NT-proBNP与原始细胞值以及NT-proBNP与乳酸脱氢酶（LDH）之间呈正线性相关。还发现LVEF与白细胞值、原始细胞值、LDH、SF与白细胞值、LVEF与NT-proBNP值以及LVEF与肌钙蛋白T值之间存在显著的线性负相关。观察到E/E' 比值与原始细胞值之间存在弱负相关。所有这些相关性均具有统计学意义（p<0.05）。
白细胞值以及评估的其他血清学标志物（NT-proBNP、肌钙蛋白T）是评估蒽环类药物诱导的心脏毒性风险的有用工具。细胞毒性治疗开始时生物标志物的变化证实了早期心肌功能障碍的存在，强调了对这一特定患者群体进行系统评估的重要性。
