CIMT 不能识别儿童急性淋巴细胞白血病幸存者的早期血管变化。

CIMT does not identify early vascular changes in childhood acute lymphoblastic leukemia survivors.

机构信息

Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland.

Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.

出版信息

Adv Clin Exp Med. 2020 Feb;29(2):243-249. doi: 10.17219/acem/115082.

DOI:10.17219/acem/115082

PMID:32073764

Abstract

BACKGROUND

Childhood acute lymphoblastic leukemia (ALL) survivors are at an increased risk of cardiovascular disease development. It is believed that in the general population, this risk can be predicted with carotid intima-media thickness (CIMT) measurement.

OBJECTIVES

The objective of this study was to assess CIMT and to investigate the effects of blood pressure (BP) and lipid profile values on CIMT in childhood ALL survivors.

MATERIAL AND METHODS

The study group comprised 81 childhood ALL survivors aged 5-25 years. The control group consisted of 52 ageand sex-comparable healthy children. Carotid intima-media thickness measurement, 24-hour BP monitoring and lipid profiles were evaluated in patients and controls.

RESULTS

Despite significantly higher proportion of subjects with arterial hypertension (AH) (30/81 vs 10/52; p = 0.0315), the mean values of CIMT were not statistically different in childhood ALL survivors as compared to controls (0.4303 ±0.03 vs 0.4291 ±0.03; p = 0.81 and 1.096 ±0.74 vs 1.027 ±0.55; p = 0.56, respectively). Carotid intima-media thickness values were not statistically higher in ALL survivors with AH as compared to ALL survivors with normal BP (0.433 ±0.03 vs 0.428 ±0.03; p = 0.82). A significant positive correlation between 24-hour systolic BP standard deviation score (SDS) and CIMT-SDS in childhood ALL survivors was found (r = 0.29, p = 0.009), whereas such correlation was not observed in healthy controls (r = 0.12, p = 0.39). A significant correlation between z-score body mass index (BMI) and CIMT was found in controls (r = 0.29, p = 0.031) but not in childhood ALL survivors (r = -0.05, p = 0.64). No significant correlations between CIMT and other measured variables were found. Carotid intima-media thickness did not significantly correlate with time since ALL diagnosis (r = 0.09, p = 0.39).

CONCLUSIONS

Carotid intima-media thickness measurement shows limited feasibility and diagnostic accuracy for early assessment of vascular alteration in childhood ALL survivors. Other tests are needed to predict cardiovascular risk in childhood ALL survivors at the early stage of the follow-up.

摘要

背景

儿童急性淋巴细胞白血病（ALL）幸存者发生心血管疾病的风险增加。据信，在普通人群中，可以通过测量颈动脉内膜-中层厚度（CIMT）来预测这种风险。

目的

本研究旨在评估 CIMT，并探讨血压（BP）和血脂谱值对儿童 ALL 幸存者 CIMT 的影响。

材料和方法

研究组包括 81 名年龄在 5-25 岁的儿童 ALL 幸存者。对照组由 52 名年龄和性别匹配的健康儿童组成。对患者和对照组进行颈动脉内膜-中层厚度测量、24 小时血压监测和血脂谱评估。

结果

尽管患有动脉高血压（AH）的患者比例明显更高（30/81 与 10/52；p = 0.0315），但与对照组相比，儿童 ALL 幸存者的平均 CIMT 值无统计学差异（0.4303±0.03 与 0.4291±0.03；p = 0.81 和 1.096±0.74 与 1.027±0.55；p = 0.56）。与血压正常的 ALL 幸存者相比，患有 AH 的 ALL 幸存者的 CIMT 值并没有统计学上的升高（0.433±0.03 与 0.428±0.03；p = 0.82）。在儿童 ALL 幸存者中，24 小时收缩压标准差评分（SDS）与 CIMT-SDS 之间存在显著正相关（r = 0.29，p = 0.009），而在健康对照组中则没有观察到这种相关性（r = 0.12，p = 0.39）。在对照组中，z 评分体重指数（BMI）与 CIMT 之间存在显著相关性（r = 0.29，p = 0.031），但在儿童 ALL 幸存者中则没有（r = -0.05，p = 0.64）。未发现 CIMT 与其他测量变量之间存在显著相关性。CIMT 与 ALL 诊断后时间无显著相关性（r = 0.09，p = 0.39）。