急性淋巴细胞白血病患儿粒细胞缺乏并革兰阴性杆菌感染时血清内源性二氧化硫水平变化及其意义

目的 探讨内源性二氧化硫(SO2)在急性淋巴细胞白血病(ALL)患儿大剂量阿糖胞苷(HD-AraC)化疗后粒细胞缺乏期并革兰阴性杆菌感染时的水平变化及其病理生理学意义.方法 2010年1-12月在本院儿童血液肿瘤科住院的ALL患儿共31例,均行HD-AraC化疗,均出现骨髓抑制期并革兰阴性杆菌感染.分别测定患儿化疗前(WBC>3.0×109 L-1)、化疗后骨髓抑制期未感染时(WBC<1.0×109 L-1)、化疗后骨髓抑制期并革兰阴性杆菌感染时(WBC<1.0×109 L-1)及感染控制后粒细胞恢复期(WBC>2.0×109 L-1)血清SO2、CRP、IL-6和IL-8水平变化,分析其变化趋势.结果 ALL患儿化疗后,骨髓抑制期未合并感染时其血清SO2水平[(8.91±3.80) μmol·L-1]较化疗前[(6.15±3.16) μmol·L-1]明显升高(P<0.05);并革兰阴性杆菌感染后其血清SO2水平[(24.39±7.84) μmol·L-1]较未合并感染时进一步升高,差异有统计学意义(P<0.01);而感染控制后患儿血清SO2水平[(5.09±3.02) μmol·L-1]较感染组显著下降(P<0.01).与恢复期比较,骨髓抑制期粒细胞缺乏并革兰阴性杆菌感染后患儿血清CRP[(35.72±14.97) mg·L-1 vs (2.39±1.66) mg·L-1]、IL-6[(152.24±20.42) ng·L-1 vs (121.26±15.50) ng·L-1]和IL-8[(222.35±39.79) ng·L-1 vs (124.36±13.28) ng·L-1]水平均显著升高(Pa<0.01).结论 内源性SO2可以作为一种生物活性分子,参与ALL患儿粒细胞缺乏时革兰阴性杆菌感染的调节过程.

Changes in Serum Levels of Endogenous Sulfur Dioxide in Childhood Acute Lymphoblastic Leukemia with Neutropenia and Gram-Negative Bacteria Infection and Its Significance of Pathophysiological Role

Objective To investigate the pathophysiological role and changes in serum levels of endogenous sulfur dioxide(SO2) in childhood acute lymphoblastic leukemia(ALL) with neutropenia before and after high-dose cytarabine(HD-AraC) chemotherapy,and(or) with Gram-negative(G-) bacteria infection.Methods From Jan.2010 to Dec.2010 in Capital Medicine University Shijitan Hospital,31 ALL children who underwent HD-AraC chemotherapy in the Department of Pediatric Oncology and Hematology were studied.During the bone marrow suppression stage,all children were complicated with G-bacteria infection.The serum content of SO2,C reactive protein(CRP),interleukin 6(IL-6) and IL-8 before the chemotherapy(WBC>3.0×109 L-1),bone marrow suppression stage after the chemotherapy with and without G-bacteria infection(WBC<1.0×109 L-1),and the serum levels during granulocyte recovery after infection control(WBC>2.0×109 L-1) were detected respectively and the trend of the changes were analyzed.Results After chemotherapy,serum SO2 contents of all the children[(8.91±3.80) μmol·L-1] were increased obviously compared with those before chemotherapy [(6.15±3.16) μmol·L-1](P<0.05).When these children were complicated with G-bacteria infection,the serum SO2 content[(24.39±7.84) μmol·L-1] was further increased significantly compared with that without infection(P<0.01).Whereas,the SO2 serum content[(5.09±3.02) μmol·L-1] had a decreased trend after the infection was controlled.Compared with that with G-bacteria infection,the difference was signi-ficant(P<0.01).Meanwhile,after combined with G-bacteria bacillus infection,the serum levels of CRP[(35.72±14.97) mg·L-1 vs(2.39±1.66) mg·L-1],IL-6 [(152.24±20.42) ng·L-1 vs(121.26±15.50) ng·L-1] and IL-8[(222.35±39.79) ng·L-1 vs(124.36±13.28) ng·L-1] were increased significantly,compared with those infection was controlled(Pa<0.01).Conclusion Endogenous SO2 can be a bioactive molecule involved in the adjustment process of ALL children with neutropenia and G-bacteria infection.