摘要
目的分析视网膜母细胞瘤（RB）中枢神经系统（CNS）转移组和眼外期组患儿化疗前后血清及脑脊液（CSF）实验室指标的变化及临床意义。方法收集2005年9月至2013年12月北京同仁医院收治及规范化疗的11例诊断为CNS转移患儿（CNS转移组）的临床资料，并依据年龄、性别、眼别选择同期北京同仁医院11例眼外期患儿入RB眼外期组。22例患儿均规范化疗6个周期，化疗方案均为卡铂＋替尼泊苷＋长春新碱／卡铂＋依托泊苷＋长春新碱（CTV／CEV），每个周期化疗均行腰椎穿刺及鞘注治疗。CNS转移组和眼外期组均在化疗前、化疗第3个周期及第6个周期后行血清神经元特异性烯醇化酶（NSE）、血清乳酸脱氢酶（LDH）和CSF的NSE、蛋白定量及白细胞计数的监测。应用重复测量数据的多因素方差分析比较2组各项实验室指标在化疗前后的变化。结果CNS转移组化疗前及化疗第6个周期后血清NSE值分别为（120．19±105．19）μg/L和（39．07±24．10）μg/L，眼外期组化疗前及化疗第6个周期后血清NSE值分别为（29．03±11．94）μg/L和（21．03±5．01）μg/L，2组血清NSE值在化疗前后的变化有统计学意义（F=7．115，P=0．000），CNS转移组血清NSE水平明显高于眼外期组（F=41．500，P=0．007）。2组血清LDH值化疗前后变化无统计学意义（F=0．892，P=0．525）。CNS转移组CSF-NSE水平明显高于眼外期组（F=15．706，P=0．001）。CNS转移组CSF-蛋白定量水平明显高于眼外期组（F=15．228，P=0．001）。CNS转移组CSF-白细胞计数明显高于眼外期组（F=5．514，P=0．003）。结论血清NSE水平可作为监测RB患儿CNS转移期及眼外期病情变化的实验室指标。CSF-NSE值的动态监测可作为诊断CNS转移及监测病情的实验室指标。CSF-蛋白定量及CSF-白细胞计数可作为诊断CNS转移的辅助实验室指标。血清LDH水平尚不能作为诊断及监测CNS转移期及眼外期的实验室指标。
Objective To analyze the changes of laboratory indices in serum and cerebrospinal fluid（CSF） for children retinoblastoma（RB） before and after chemotherapy between central nervous system （CNS） metastasis group and extraoeular stage group, and to conclude the clinical significance. Methods From September 2005 to December 2013,11 cases were collected in Beijing Tongren Hospital who were diagnosed as CNS metastasis and were assorted into CNS metastasis group. According to age, gender and eye difference, 11 cases were chosen for the extraocular stage group. Twenty - two cases were given 6 cycles of chemotherapy. The chemotherapy protocol was Carboplatin ＋ Tenipo- side ＋ Vineristine（CTV）or Carboplatin ＋ Etoposide ＋ Vincristine（CEV）. In each chemotherapy cycle all patients underwent lumbar puncture and intratheeal injection therapy. Serum levels of neuron specific enolase （NSE）, serum lactate dehydrogenase （LDH） and CSF levels of NSE, quantitative protein and white blood cell count of the two groups were monitored before initiating chemotherapy and after the third and sixth cycles of chemotherapy. Multi factor variance analysis of the data was compared between the two groups in the dynamic changes of laboratory indices before and after chemotherapy using repeated measurements. Results The serum NSE levels of CNS metastasis group before initiating chemotherapy and after the 6th cycle of chemotherapy were （ 120.19 ± 105.19） μg/L and （39.07 ±24.10） μg/L,respectively. The serum NSE levels of extraocular stage group before initiating chemotherapy and after the 6th cycle of chemotherapy were （29.03 ± 11.94 ） μg/L and （ 21.03 ± 5.01 ） μg/L, respectively. Serum NSE levels of the two groups showed significant changes before and after chemotherapy （F = 7. 115 ,P = 0. 000）. Serum NSE level of CNS metastasis group was significantly higher than that of the extraocular stage group （ F = 41. 500, P = 0. 007 ）. Serum LDH levels of the two groups showed no statistically significant changes before and after chemotherapy （ F = 0. 892, P = 0. 525 ）. The CSF - NSE level of CNS metastasis group was significantly higher than that of extraocular stage group（ F = 15. 706 ,P = 0. 001 ）. CSF quantitative protein level of the CNS metastasis group was significantly higher than that of extraocular stage group（ F = 15. 228, P = 0. 001 ）. CSF white blood cell count of the CNS metastasis group were signifi- cantly higher than that of extraocular stage group （ F = 5.514, P = 0.003 ）. Conclusions Serum NSE level can be used as a laboratory indicator for monitoring CNS metastasis stage and extraocular stage of RB. The CSF - NSE values can be used as a diagnostic tool for CNS metastasis and monitoring of disease progression. CSF quantitative protein and white blood cell count can be used as auxiliary laboratory index for CNS metastasis diagnosis. Serum LDH cannot be used as a valuable laboratory index for diagnosis of CNS metastasis cases and extraocular cases.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2015年第15期1157-1160,共4页
Chinese Journal of Applied Clinical Pediatrics
