Proc Patrycja, Szczepańska Joanna, Zubowska Małgorzata, Wyka Krystyna, Młynarski Wojciech
Department of Paediatric Dentistry, Medical University of Lodz, Pomorska 251, 92-213 Lodz.
Department of Pediatrics, Diabetology, Endocrynology and Nephrology.
Medicine (Baltimore). 2020 Oct 16;99(42):e22802. doi: 10.1097/MD.0000000000022802.
The agents used in the treatment of acute lymphoblastic leukaemia (ALL) might affect the oral health of cancer patients.The study aims to assess the changes in the levels of immunoglobulin A (IgA) in saliva and blood, during first 22 days of intensive chemotherapy of ALL in children.Saliva and blood samples were taken from 24 patients, including 13 boys and 11 girls (age range: 4 - 17 years) on days 1, 8 and 22 of treatment. The levels of immunoglobulin A and total protein were estimated in samples at each time-point. The distribution of the quantitative variables was assessed using the Shapiro-Wilk test. Non-parametric statistics were used to compare the levels of repeated measurements and post hoc non-parametric analysis was applied for between time-point comparisons.A constant relationship was found between the levels of Ig A in blood and saliva (r = 0.28; P = .031). No change in salivary IgA level was observed in the prednisone-only prephase, but it dropped significantly on day 22 (10.7+/-4.8 vs 9.6+/-6.4 vs 5.7+/-3.9 ng/mL; P = .04), when chemotherapy was given (anthracycline, vincristine, L-asparaginase).In blood, the total protein level decreased significantly between day 1 and 22 (6.2+/-0.4 vs 5.1+/-0.3 g/dL; P = .001). Lymphocyte count (per microliter) also decreased (2.12+/-0.8 vs 0.41+/-0.1 vs 1.08+/-0.5; P = .002). Four children suffered from oral mucositis graded 1 or higher between days 8 and 22.Chemotherapy given during the treatment of childhood ALL is associated with a reduction in the level of salivary immunoglobulin A. Prevention of the drop of salivary IgA may diminish the risk of occurrence of acute mucosal complications.
用于治疗急性淋巴细胞白血病（ALL）的药物可能会影响癌症患者的口腔健康。本研究旨在评估儿童ALL强化化疗的前22天内唾液和血液中免疫球蛋白A（IgA）水平的变化。在治疗的第1天、第8天和第22天，从24名患者（包括13名男孩和11名女孩，年龄范围：4 - 17岁）采集唾液和血液样本。在每个时间点对样本中的免疫球蛋白A和总蛋白水平进行评估。使用夏皮罗-威尔克检验评估定量变量的分布。采用非参数统计比较重复测量的水平，并应用事后非参数分析进行时间点之间的比较。发现血液和唾液中IgA水平之间存在恒定关系（r = 0.28；P = 0.031）。在仅使用泼尼松的前期未观察到唾液IgA水平变化，但在给予化疗（蒽环类药物、长春新碱、L-天冬酰胺酶）的第22天，其显著下降（10.7±4.8 vs 9.6±6.4 vs 5.7±3.9 ng/mL；P = 0.04）。血液中，总蛋白水平在第1天和第22天之间显著下降（6.2±0.4 vs 5.1±0.3 g/dL；P = 0.001）。淋巴细胞计数（每微升）也下降（2.12±0.8 vs 0.41±0.1 vs 1.08±0.5；P = 生002）。4名儿童在第8天至第22天之间出现了1级或更高等级的口腔黏膜炎。儿童ALL治疗期间给予的化疗与唾液免疫球蛋白A水平降低有关。预防唾液IgA下降可能会降低急性黏膜并发症的发生风险。
