儿童恶性肿瘤化疗后性激素监测及意义

目的:探讨化疗药物损伤生殖功能的指标及意义。方法:本组35例,年龄0.8～7岁。其中18例肾母细胞瘤应用NWTS-4方案化疗(Ⅰ、Ⅱ期给予长春新碱+更生霉素,Ⅲ期以上给以VCR+表阿霉素+足叶乙甙/环磷酰胺交替),9例神经母细胞瘤应用OPEC/OPAC(长春新碱+环磷酰胺+卡铂+足叶乙甙/长春新碱+环磷酰胺+顺铂+表阿霉素)交替方案,3例膀胱横纹肌肉瘤应用VAC/VDC(长春新碱+表阿霉素+环磷酰胺+顺铂/长春新碱+更生霉素+环磷酰胺+顺铂)交替方案,5例睾丸卵黄囊瘤应用PEB/PVB(长春新碱+更生霉素+环磷酰胺+顺铂/顺铂+博来霉素+足叶乙甙)交替方案。化学发光法检测血清性激素FSH、LH、PRL、E2及T。结果:35例化疗前FSH值均在正常范围,在第一疗程结束后,91.43%(32/35)血清FSH高于正常上限值,其中9例(100%)为神经母细胞瘤,3例(100%)为膀胱横纹肌肉瘤,5例(100%)为睾丸卵黄囊瘤,15例(83.33%)为肾母细胞瘤(Ⅲ期及以上)。32例血清FSH异常升高者,其化疗方案中均含有烷化剂和/或铂类化疗药物。连续检测12例肿瘤患者每疗程化疗后血清FSH,均逐渐升高。结论:血清FSH异常升高可能反映睾丸生殖功能损伤,且烷化剂类及铂类化疗药物对FSH值影响最明显。

Monitoring and Significance of Gonadal Hormone Post-chemotherapy in Children Malignant

Objective：To investigate the indicators and significances of the reproductive function ofchemotherapy drug injury.Methods：A total of 35 patients of children cancer were included aged at 0.8-7 years.TheNWTS-4 program（VCR＋AMD to Ⅰ and Ⅱ stage,VCR＋ADR＋VP-16/CP to Ⅲ stage and above） was used byWilms＇ tumor in 18 cases.The OPEC or OPAC program（CVR＋CP＋CDDP/PC＋ADR＋VP-16） was alternatively usedby neuroblastoma in 9 cases.The VAC or VDC program（VCR＋CDDP＋CP＋ADR＋AMD） was alternated by thebladder rhabdomyosarcoma in 3 cases.The PEB or PVB program（CDDP＋BLM＋VP-16/VCR） was alternated by thetesticular yolk sac tumor in 5 cases.Endocrinological parametera including follicle-stimulating hormone（FSH）,luteinizing hormone（LH）,prolactin（PRL）,estradiol（E2） and total testosterone（T） were assay by the radioimmunoassay.Results：In pre-chemotherapy,FSH values of 35 patients were within normal range.In the second stage of postchemotherapy,32/35（91.43%） had FSH levels above the normal reference value of 0.57 mIU/ml,9 cases（100%）in neuroblastoma,3（100%） in bladder rhabdomyosarcoma,5 cases（100%） in testicular yolk sac tumor and 15cases（83.33%） in Wilms＇ tumor which was the Ⅲ stage and above of clinic,respectively.Both alkylating agentchemotherapy and/or platinum chemotherapy drugs were used by the 32 patients.Serum FSH values was graduallyincreased in 12 patients with each stage of chemotherapy.Conclusion：Abnormal elevation of serum FSH mayreflect gonadal function injury,and the alkylating agent and platinum chemotherapy drugs are most obvious on theFSH values.