CAJ | 학술논문

目的研究治疗剂量的三氧化二砷(As2O3)对小儿急性早幼粒细胞白血病(APL)肾脏的毒性.方法对37例小儿APL静脉滴注As2O3患者进行肾脏毒性监测:尿常规、尿微量蛋白[α1-微球蛋白(α1-MG)、微量清蛋白(mAlb)、β2-微球蛋白(β2-MG)、转铁蛋白(TRF)]定量、肾功能等检查.结果治疗前白细胞尿5例(13.5%),治疗后第1周复查均转为正常;治疗前红细胞尿3例(8.1%);蛋白尿6例(16.2%);酮体(2+～3+)6例(16.2%),考虑与发热、进食少有关,1周后消失;血清尿素氮(BUN)、肌酐(Cr)、尿酸(UA)在诱导缓解期均未见异常性改变;与治疗前相比,尿α1-MG在第2周明显升高;β2-MG在第3周明显升高(P＜0.01),但恢复较慢,第5周与α1-MG共同恢复正常.mAlb和TRF在诱导缓解期未见明显改变.结论常规剂量As2O3治疗小儿APL肾脏毒性较轻,存在一过性肾小管的功能损害,诱导缓解期的第2～5周是重点监测时期.As2O3累积量的变化,对小儿肾脏功能的近期影响不大.尿微量蛋白联合检测比传统的血BUN、Cr更能反应肾小管的损害程度,动态检测其变化可以早期发现砷剂的肾脏损害.
목적 연구치료제량적삼양화이신(As2O3)대소인급성조유립세포백혈병(APL)신장적독성.방법 대37례소인APL정맥적주As2O3환자진행신장독성감측:뇨상규、뇨미량단백[α1-미구단백(α1-MG)、미량청단백(mAlb)、β2-미구단백(β2-MG)、전철단백(TRF)]정량、신공능등검사.결과 치료전백세포뇨5례(13.5%),치료후제1주복사균전위정상;치료전홍세포뇨3례(8.1%);단백뇨6례(16.2%);동체(2+～3+)6례(16.2%),고필여발열、진식소유관,1주후소실;혈청뇨소담(BUN)、기항(Cr)、뇨산(UA)재유도완해기균미견이상성개변;여치료전상비,뇨α1-MG재제2주명현승고;β2-MG재제3주명현승고(P＜0.01),단회복교만,제5주여α1-MG공동회복정상.mAlb화TRF재유도완해기미견명현개변.결론 상규제량As2O3치료소인APL신장독성교경,존재일과성신소관적공능손해,유도완해기적제2～5주시중점감측시기.As2O3루적량적변화,대소인신장공능적근기영향불대.뇨미량단백연합검측비전통적혈BUN、Cr경능반응신소관적손해정도,동태검측기변화가이조기발현신제적신장손해.
Objective To study the renal toxicity of arsenic trioxide (As2O3) with therapeutic dose in acute promyelocytic leukemia (APL) in childhood. Methods Renal toxicity of 37 APL was monitored. The examinations of urinary routine, urinary microproteins[αt1-microglobulin (α1-MG), microalbumin (mAlb),β2-microglobulin (β2-MG), transferrin(TRF)] and renal function were performed. Results Five cases with leukocyturia, three cases with hematuria, six cases with proteinuria were observed before therapy. Ketonuria occurred in six cases associated with fever and less diet; overall abnormality disappeared in the first week. No significant changes of blood uric nitrigen(BUN), serum creatinine(Cr) and uric acid (UA) were founded in induction remission. Compared with tests before As2O3 infusion, obvious increase of uric α1-MG occurred in second week with arsenic trioxide, obvious increase of uric β2-MG in third week (P ＜0.01), slow recovery of uric α1-MG and β2-MG in fifth week. No significant changes of uric mAlb and TRF were seen in induction remission. Conclusion The renal toxicity of As2O3 was gentle in general therapeutic dose, renal tubercular damage could be seen. The important monitoring period were the second to fifth week in induction remission.Influence of As2O3 cumulant on renal function was not serious in the near future in childhood. The combined detection of urinary microproteins with dynamic variety could detect early renal damage with As2O3.