Pastore G, Saracco P, Brach del Prever A, Iannacci L, Miniero R, Madon E
Acta Haematol. 1984;72(6):384-7. doi: 10.1159/000206424.
Oral glucose tolerance tests were performed in 47 children with acute lymphoblastic leukemia (ALL), treated according to 2 consecutive protocols. Glucose and insulin values were assessed before and after L-asparaginase (L-asp). 30 children (group A) received L-asp as a single-agent consolidation course, after achieving remission with vincristine (VCR) and prednisone (PDN). Normal insulin and glucose levels were found in all patients before L-asp; 4 children (13%) had a transient impaired glucose tolerance (IGT) after completing L-asp therapy. 17 children (group B) were given L-asp during induction therapy with VCR and PDN, and all achieved complete remission. 5 patients (23%) had IGT, without hypoinsulinemia, before L-asp administration. IGT normalized in 4 patients after L-asp, the other children developed a diabetes mellitus. Only 1 patient, with a normal IGT test before L-asp therapy, showed a transient IGT after L-asp. In patients with ALL, the presence of IGT before treatment may be related to leukemia. The concomitant use of steroids does not influence the incidence of IGT in our series. Our data reveal normal insulinemia in patients with IGT. Thus, the leukemic process itself may play a much more significant role in inducing abnormalities in carbohydrate metabolism.
对47例急性淋巴细胞白血病（ALL）患儿进行了口服葡萄糖耐量试验，这些患儿按照连续两个方案进行治疗。在使用L-天冬酰胺酶（L-asp）前后评估血糖和胰岛素值。30名儿童（A组）在使用长春新碱（VCR）和泼尼松（PDN）达到缓解后，接受L-asp作为单药巩固疗程。在使用L-asp之前，所有患者的胰岛素和血糖水平均正常；4名儿童（13%）在完成L-asp治疗后出现短暂的糖耐量受损（IGT）。17名儿童（B组）在使用VCR和PDN进行诱导治疗期间接受L-asp，所有患者均实现完全缓解。5名患者（23%）在使用L-asp之前存在IGT，但无低胰岛素血症。4名患者在使用L-asp后IGT恢复正常，其他儿童发展为糖尿病。只有1名在使用L-asp治疗前IGT试验正常的患者在使用L-asp后出现短暂的IGT。在ALL患者中，治疗前IGT的存在可能与白血病有关。在我们的系列研究中，同时使用类固醇并不影响IGT的发生率。我们的数据显示IGT患者存在正常胰岛素血症。因此，白血病过程本身在诱导碳水化合物代谢异常方面可能起更重要的作用。
