左卡尼汀对柔红霉素诱导的急性淋巴细胞白血病患儿血浆N 末端脑利钠肽原的影响

中国临床药理学与治疗学 ›› 2009, Vol. 14 ›› Issue (9): 1052-1055.

左卡尼汀对柔红霉素诱导的急性淋巴细胞白血病患儿血浆N 末端脑利钠肽原的影响

王菊香¹, 朱新波², 曾炜炜¹, 钱江潮¹, 周海霞¹, 黄珍¹, 方希敏¹, 徐霞¹, 李原¹

¹温州医学院附属育英儿童医院血液科, 温州325027, 浙江;
²温州医学院药理学教研室, 温州325035, 浙江

收稿日期:2009-07-06 修回日期:2009-09-19 发布日期:2020-11-03
作者简介:王菊香, 女, 硕士, 副主任医师, 研究方向:儿童血液肿瘤疾病的临床研究。Tel:13868840805 E-mail: zjwzwjx@163.com
基金资助:
温州市科技局项目基金资助(Y20070116)

Effects of levocarnitine oral solution on the plasma N-terminal probrain natriuretic peptide levels in children with acute lymphocytic leukemia treated by daunorubicin

WANG Ju-xiang¹, ZHU Xin-bo², ZENG Wei-wei¹, QIAN Jiang-chao¹, ZHOU Hai-xia¹, HUANG Zhen¹, FANG Xi-min¹, XU Xia¹, LI Yuan¹

¹Department of Hematology, the Affiliated Children's Hospital, Wenzhou Medical College, Wenzhou 325027, Zhejiang, China;
²Department of Pharmacology, Wenzhou Medical College, Wenzhou 325035, Zhejiang, China

Received:2009-07-06 Revised:2009-09-19 Published:2020-11-03

摘要/Abstract

摘要： 目的: 通过观察急性淋巴细胞白血病患儿应用柔红霉素(daunorubicin, DNR) 化疗后其血浆N 末端脑利钠肽原(N-terminal pro-brain natriureticpeptide, NT-pro BNP) 水平的改变及应用左卡尼汀心肌保护药物后NT-pro BNP 水平的变化, 探讨能早期监测DNR 心肌毒性并可筛选出更好保护心肌药物的指标。方法: 选择2006-2008 年新诊断的急性淋巴细胞白血病患儿22 例, 均采用长春新碱+柔红霉素+左旋门冬酰胺酶+泼尼松(VDLP) 方案诱导化疗, 化疗期间分别应用左卡尼汀口服液(Levocarnitine oral solution) (治疗组) 或未予任何心肌保护药物(对照组) 。在应用DNR前后用交体基免疫分析法测定患儿血浆NT-proBNP 水平, 并同时常规检测患儿化疗前后心肌肌钙蛋白I(cTnI) 、心肌酶谱(LDH1 、CPK-MB) 及心电图(ECG) 。结果: 治疗组(L-CN 组) 患儿化疗后血浆NT-pro BNP 浓度从(53±11) pg/mL 增加到(162±27) pg/mL (P < 0.01) 。对照组从(51±10) pg/mL 增加到(194±38) pg/mL(P <0.01) 。两组化疗前NT-pro BNP 水平差异无统计学意义(P >0.05), 而化疗后治疗组(L-CN 组) 患儿血浆NT-pro BNP 水平较对照组低(P <0.05), 治疗组治疗后血浆NT-pro BNP 的改善情况优于对照组。两组化疗前后ECG 及cTnI 、LDH1 、CPK-MB 均无明显变化(P >0.05) 。结论: 在急性淋巴细胞白血病患儿应用DNR 化疗时, NT-pro BNP 可用于监测其对心脏的早期影响, 左卡尼汀对NT-pro BNP 的改善程度较对照组明显。

关键词: 左卡尼汀, 柔红霉素, 肽碎片, 利钠肽, 脑, 白血病, 急性, 儿童

Abstract: AIM: To explore the value of N-terminal pro-brain natriuretic peptide (NT-pro BNP) in diagnosing the myocardiopathy induced by daunorubicin (DNR) and the more effective cardiac-protection drugs by investigating the changes of the NT-pro BNP levels after administrating DNR in children with acute lymphocytic leukemia. METHODS: Twenty-two children with acute lymphocytic leukemia who treated with DNR containing vincristine, L-asparaginase, prednisone, were randomly divided into two groups. The therapy group received L-CN as the cardiac-protection drug and the control group without protecting heart drug during chemotherapy with DNR. The level of NT-pro BNP in plasma was measured by immunoassay before and after using DNR and the cardiac troponin I(cTnI) and cardiac muscle enzyme (LDH1, CPK-MB) and ECG were detected before and after chemotherapy. RESULTS: The level of NT-pro BNP in plasma was increased from (53±11) pg/mL to (162±27) pg/mL (P <0.01) in the therapy group after chemotherapy and which in the control group was increased from (51±10) pg/mL to (194±38) pg/mL (P <0.01). There was no significant difference in the level of NT-pro BNP before chemotherapy between two groups. The level of NT-pro BNP in plasma was lower in the therapy group than that in the control group(P <0.05). The improving condition of the level of NT-pro BNP in the therapy group was better than that in the control group after chemotherapy. There were no significant difference in the ECG and cTnI and LDH1, CPK-MB in two groups before and after chemotherapy. CONCLUSION: NT-pro BNP can be served as a good indicator for DNR-induced myocardiopathy. Compared with control group, the improving condition of NT-pro BNP is obvious treated with levocarnitine.

Key words: levocarnitine, daunorubicin, peptide fragments, natriuretic peptide, brain, acute leukemia, child

中图分类号:

R979.1

王菊香, 朱新波, 曾炜炜, 钱江潮, 周海霞, 黄珍, 方希敏, 徐霞, 李原. 左卡尼汀对柔红霉素诱导的急性淋巴细胞白血病患儿血浆N 末端脑利钠肽原的影响[J]. 中国临床药理学与治疗学, 2009, 14(9): 1052-1055.

WANG Ju-xiang, ZHU Xin-bo, ZENG Wei-wei, QIAN Jiang-chao, ZHOU Hai-xia, HUANG Zhen, FANG Xi-min, XU Xia, LI Yuan. Effects of levocarnitine oral solution on the plasma N-terminal probrain natriuretic peptide levels in children with acute lymphocytic leukemia treated by daunorubicin[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(9): 1052-1055.

参考文献

[1] Lipshultz SE. Exposure to anthracyclines during childhood causes cardiac injury[J]. Semin Oncol, 2006, 33(3 Suppl 8): 8-14.
[2] 中华医学会儿科学分会血液学组.儿童急性淋巴细胞性白血病诊治建议[J]. 中华儿科杂志, 2006, 44(5): 392-395.
[3] 刘德新. 药物性心肌病1 例[J]. 实用儿科临床杂志, 2003, 18(3): 231.
[4] Elliott P.Pathogenesis of cardiotoxicity induced by anthracyclines[J]. Semin Oncol, 2006, 33(3 Suppl 8): S2-S7.
[5] Iwanaga Y, Nishi I, Furuichi S, et al.B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart fai1ure: comparison between systolic and diastolic heart failure[J]. J Am Coil Cardiol, 2006, 47(4): 742-748.
[6] Mir TS, Marohn S, Laer S, et a1.P1asma concentrations of N-terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heart failure[J]. Pediatrics, 2002, 110(6): e76.
[7] 武育蓉, 陈树宝, 黄美蓉.氨基末端脑利钠肽前体在室间隔缺损合并心力衰竭诊断中的价值[J]. 中华儿科杂志, 2005, 43(3): 161-164.
[8] Germanakis I, KalmantiM, Parthenakis F, et al. Correlation of plasma N-terminal pro-brain natriuretic peptide levels with left ventricle mass in children treated with anthracyclines[J]. Int J Cardiol, 2006, 108(2): 212-215.
[9] Simpson C, Herr H, Courville KA.Concurrent therapies that protect against doxorubicin-induced cardiomyopathy[J]. Clin J Oncol Nurs, 2004, 8(5): 497-501.
[10] Wouters KA, Kremer LC, Miller TL, et al. Protecting against anthracycline-induced myocardial damage: a review of the most promising strategies[J]. Br J Haematol, 2005, 131(5): 56l-578.
[11] Hong YM, Kim HS, Yoon HR.Serum lipid and fatty acid profiles in adriamycin-treated rats after administration of L-carnitine[J]. Pediatr Res, 2002, 51(2): 249-255.

[1]	毛君, 荣玉, 李炎根, 熊登喜, 赵鹏, 查正江. 氟比洛芬酯在颅脑损伤患者镇痛治疗中的临床应用效果观察及安全性分析[J]. 中国临床药理学与治疗学, 2023, 28(9): 1056-1060.
[2]	王坤, 许佩佩, 周兰兰, 鲁晟. 人参皂苷Rg1调控Epac1/Rap1信号通路对缺血性脑卒中大鼠神经保护作用机制研究[J]. 中国临床药理学与治疗学, 2023, 28(7): 721-727.
[3]	郝潇, 赵美, 王文静, 张飞飞, 刘惠良, 党懿, 李树仁, 齐晓勇. 钠-葡萄糖共转运体2抑制剂在急性心肌梗死应用研究进展[J]. 中国临床药理学与治疗学, 2023, 28(7): 824-831.
[4]	李青华, 赵艳, 赵海港, 高朋飞, 徐炳欣. ABCB1 G2677T 基因多态性检测在缺血性脑卒中患者应用阿托伐他汀降脂治疗中的价值[J]. 中国临床药理学与治疗学, 2023, 28(6): 633-640.
[5]	钱锦, 王峰岩. 老年急性心肌梗死患者PCI术后血清NT-proBNP水平的影响因素并分析其对近期预后的影响[J]. 中国临床药理学与治疗学, 2023, 28(6): 658-665.
[6]	吴雄志, 王宣, 徐四七, 居霞, 王胜斌, 陈永权. 咪达唑仑口服溶液比右美托咪定喷鼻更有效缓解儿童术前焦虑[J]. 中国临床药理学与治疗学, 2023, 28(6): 666-670.
[7]	秦文秀, 许军峰, 杨婷, 王坪霏. 丹参酮IIA治疗缺血性脑卒中后神经损伤的信号通路研究进展[J]. 中国临床药理学与治疗学, 2023, 28(6): 705-713.
[8]	朱丽, 魏兵, 廖世峨, 张超, 郑晓宇, 刘亚军. 药物代谢酶细胞色素P450单核苷酸多态性影响哮喘儿童吸入皮质醇激素疗效研究[J]. 中国临床药理学与治疗学, 2023, 28(5): 536-543.
[9]	徐渭, 陈峰, 叶志军. 金丝桃苷调节RhoA/ROCK信号通路对创伤性脑损伤大鼠的影响[J]. 中国临床药理学与治疗学, 2023, 28(4): 383-390.
[10]	柳彤, 徐佳明, 王金伙, 尹磊, 陈永权, 郭建荣. 急性等容血液稀释自体血体外隔离期间血浆中麻醉药物浓度变化及回输后对麻醉效应的影响[J]. 中国临床药理学与治疗学, 2023, 28(4): 413-418.
[11]	张明康, 马彦荣, 靳永文, 周燕, 崔睿睿, 武新安. 药源性急性间质性肾炎的临床研究进展[J]. 中国临床药理学与治疗学, 2023, 28(4): 419-428.
[12]	齐晓风, 骆亚莉, 肖孟勇, 周世琴, 周雯, 安方玉, 魏本君, 刘永琦. “卫气营血”理论辨证防治急性肺损伤研究现状[J]. 中国临床药理学与治疗学, 2023, 28(4): 429-437.
[13]	吴志勇, 刘兵荣, 李彬, 汤睿. 红细胞分布宽度对急性缺血性卒中静脉溶栓早期神经功能改善不良的预测作用[J]. 中国临床药理学与治疗学, 2023, 28(3): 307-314.
[14]	张蕾, 肖兴鹏, 丁煌. 沉默ZKSCAN3基因表达加重脂多糖诱导的小鼠肺损伤[J]. 中国临床药理学与治疗学, 2023, 28(2): 164-170.
[15]	黄凯歌, 许勤华, 王伟. 血糖、血钙对急性重症胰腺炎患者预后影响的交互作用及预测效能研究[J]. 中国临床药理学与治疗学, 2023, 28(11): 1227-1234.