摘要
目的:探讨急性淋巴细胞白血病患儿认知能力及与血浆单胺类神经递质的关系。方法:回顾性分析2018年10月至2019年4月同济大学附属同济医院31例急性淋巴细胞白血病患儿的临床资料。其中,处于完全缓解后的巩固或强化治疗阶段20例(治疗阶段组),处于完全缓解、治疗结束停药观察阶段11例(停药组)。检测患儿血浆多巴胺(DA)、5-羟色胺(5-HT)和5-羟吲哚乙酸(5-HIAA)水平,采用持续性字色测验(CPT)和Stroop测验进行认知功能测定。并与20例健康体检儿童(健康对照组)进行比较。结果:三组血浆DA和5-HIAA比较差异无统计学意义(P>0.05)。治疗阶段组5-HT明显低于健康对照组[1769.69(912.86,2812.56)ng/L比3085.29(2191.79,5310.13)ng/L],差异有统计学意义(P<0.05),停药组与健康对照组5-HT比较差异无统计学意义(P>0.05)。CPT结果显示,三组错误数比较差异无统计学意义(P>0.05);治疗阶段组和停药组正确数明显少于健康对照组[(28±12)和(33±11)个比(43±10)个],漏掉数明显多于健康对照组[(53±14)和(52±13)个比(39±14)个],差异有统计学意义(P<0.05)。Stroop测验结果显示,三组字色一致测验结果比较差异无统计学意义(P>0.05);字色矛盾测试中,治疗阶段组和停药组正确数明显少于健康对照组,错误数和漏掉数明显多于健康对照组,差异有统计学意义(P<0.05);字色无关测试中,三组错误数比较差异无统计学意义(P>0.05);治疗阶段组和停药组正确数明显少于健康对照组,停药组漏掉数明显多于健康对照组,差异有统计学意义(P<0.05)。相关性分析结果显示,急性淋巴细胞白血病患儿血浆DA与Stroop测验字色一致错误数呈负相关、与Stroop测验字色无关错误数呈正相关(P<0.05),5-HIAA与CPT正确数、Stroop测验字色一致错误数呈负相关(P<0.05或<0.01),5-HT与Stroop测验字色矛盾正确数呈正相关(P<0.05)。结论:急性淋巴细胞白血病患儿可存在持久注意力、选择性注意力损伤,血浆单胺类神经递质中5-HT水平较健康儿童下降,其注意力改变可能与单胺类神经递质水平的变化有相关性。
Objective:To study the relationship between cognitive ability and plasma monoamine neurotransmitters in children with acute lymphoblastic leukemia.Methods:The clinical data of 31 children with acute lymphoblastic leukemia from October 2018 to April 2019 in Tongji Hospital Affiliated to Tongji University were retrospectively analyzed.Among them,20 cases were in consolidation or intensive treatment stage after complete remission(treatment stage group),and 11 cases were in complete remission and drug withdrawal after treatment(withdrawal group).The plasma levels of dopamine(DA),5-hydroxytryptamine(5-HT)and 5-hydroxyindoleacetic acid(5-HIAA)were measured,the cognitive function was measured by continuous performance test(CPT)and Stroop test,and the results were compared with those of 20 healthy children(healthy control group).Results:There were no statistical differences in plasma DA and 5-HIAA among 3 groups(P>0.05).The 5-HT in treatment stage group was significantly lower than that in healthy control group:1769.69(912.86,2812.56)ng/L vs.3085.29(2191.79,5310.13)ng/L,and there was statistical difference(P<0.05).There was no statistical difference in 5-HT between withdrawal group and healthy control group(P>0.05).CPT results showed that there was no statistical difference in the number of errors among 3 groups(P>0.05);the correct number in treatment stage group and withdrawal group was significantly less than that in healthy control group:(28±12)and(33±11)pieces vs.(43±10)pieces,the missed number was significantly higher than that in healthy control group:(53±14)and(52±13)pieces vs.(39±14)pieces,and there were statistical differences(P<0.05).Stroop test results showed that,there was no statistical difference in word-color consistency test among 3 groups(P>0.05);in word-color contradiction test,the correct number in treatment stage group and withdrawal group was significantly less than that in healthy control group,the number of errors and missed were significantly more than those in healthy control group,and there were statistical differences(P<0.05);in word color irrelevance test,there was no statistical difference in the number of errors among 3 groups(P<0.05);the correct number in treatment stage group and withdrawal group was significantly less than that in healthy control group,the number of missed errors in withdrawal group was significantly more than that in healthy control group,and there were statistical differences(P<0.05).The correlation analysis results showed that plasma DA was negatively correlated with the number of errors in Stroop word-color consistency test,and positively correlated with the number of errors in Stroop irrelevance test(P<0.05);5-HIAA was negatively correlated with the correct numbers in CPT test and error number in Stroop consistency test(P<0.05 or<0.01);5-HT was positively correlated with the correct number in the word-color contradiction test(P<0.05)in children with acute lymphoblastic leukemia.Conclusions:Children with acute lymphoblastic leukemia could have continuous and selective attention injury,after being diagnosed with leukemia,the level of 5-HT in plasma monoamine neurotransmitter is lower than that in healthy children.The change of attention may be related to the change of monoamine neurotransmitter.
作者
赵焱
傅晓燕
俞海飞
潘涛
Zhao Yan;Fu Xiaoyan;Yu Haifei;Pan Tao(Department of Pediatrics,the Second Affiliated Hospital of Suzhou University,Suzhou 215000,China;Department of Pediatrics,Tongji Hospital Affiliated to Tongji University,Shanghai 200065,China;Department of Neonatology,Children's Hospital Affiliated to Suzhou University,Suzhou 215000,China)
出处
《中国医师进修杂志》
2020年第11期964-969,共6页
Chinese Journal of Postgraduates of Medicine
基金
江苏省妇幼健康科研项目(F201750)。
关键词
白血病
认知
多巴胺
血清素
羟基吲哚乙酸
回顾性研究
Leukemia
Cognition
Dopamine
Serotonin
Hydroxyindoleacetic acid
Retrospective studies
