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标题：Premature atherosclerosis after treatment for acute lymphoblastic leukemia in childhood
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作者：Elżbieta Sadurska ; Agnieszka Zaucha-Prażmo ; Agnieszka Brodzisz 等
期刊名称：Annals of Agricultural and Environmental Medicine
印刷版ISSN：1232-1966
电子版ISSN：1898-2263
出版年度：2018
卷号：25
期号：1
页码：71-76
DOI：10.5604/12321966.1230680
出版社：Institute of Agricultural Medicine in Lublin
摘要：Introduction. Late cardiovascular complications are the leading causes of morbidity and mortality in patients treated forcommon malignancies of childhood. Late cardiotoxicity include increased development of atherosclerosis and atherosclerosis– related diseases. An evaluation of the endothelium can be made based on the measurement of endothelium-derivedblood vasoactive factors, such as cytokines and adhesion molecules. Their elevated serum levels may serve as sensitiveindicators of early atherosclerotic lesions in high risk patients. Currently, assessment of common carotid intima-mediathickness has emerged as one of the more powerful tools for evaluation of subclinical atherosclerosis. The purpose of thisstudy was to compare these parameters between patients after antineoplatic treatment compared to persons not exposedto such factors.Methods. Early progression of atherosclerotic disease was evaluated in 64 survivors treated for Acute LymphoblasticLeukaemia (ALL) in childhood, and in a control group of 36 healthy volunteers. Blood serum concentrations of selected newbiomarkers, indicative of endothelial damage and inflammatory activity, were measured, including intercellular adhesionmolecule-1 (sICAM-1), endothelial leukocyte adhesion molecule-1 (E-selectin), thrombomodulin (TM), interleukin 6 (IL-6),and high-sensitivity C-reactive protein (hs-CRP). The common carotid intima-media thickness (IMT) was also assessed viaultrasound examination.Results. Significantly higher blood concentrations of sICAM-1 adhesive molecule (229.3±62.2 ng/mL vs. 199.9 ± 63.3 ng/mL, p=0.0072) and IL-6 (2.1 ± 2.7 pg/mL vs. 1.9 ± 3.6 pg/mL, p=0.0414) were found in ALL survivors compared with controlsubjects. Concentration of hs-CRP was also higher in the ALL group: 1.3 ± 2.2 ug/mL vs. 0.6 ± 0.9 ug/mL. This difference wasclose to statistical significance (p=0.0599). The mean IMT values for right and left carotid arteries were higher in ALL patientsafter antineoplastic therapy, compared with healthy subjects (IMT-R 0.056±0.008 mm vs. 0.052±0.003 mm; p=0.0021; IMT-L0.057±0.009 mm vs. 0.052±0.003 mm; p=0.0051).Conclusion. Survivors of childhood ALL in the examined group demonstrated elevated concentrations of selected newbiomarkers and increased IMT values, compared to controls, which may confirm the occurrence of endothelial injuriesin blood vessels. This study indicates that subjects treated for childhood malignancy are at a higher risk of prematurelydeveloping atherosclerosis.
关键词：nthracycline cardiotoxicity; leukemia; survivors; atherosclerosis; biomarkers; intima-media thickness