| ObjectiveAcute lymphoblastic leukemia(ALL)is the most common hematological malignancy in children.In recent years,with the continuous improvement of the cure rate,people pay more and more attention to the complications after chemotherapy.Bone change is one of its complications,which may seriously affect the long-term quality of life of children.In this study,we analyzed the changes of bone mineral density(BMD)and bone metabolism markers in children with newly diagnosed acute lymphoblastic leukemia before and after remission induction chemotherapy,to evaluated the bone quality,reduced later complications,and provided reference and suggestions for clinical intervention.Methods113 cases of ALL children who were newly diagnosed at Dalian Women andChildren Medical Center(Group)Hope Square hospital area from January 2015to January 2023 were selected.All of them were treated with the American St.Jude TOTAL XV chemotherapy regimen.Collect the basic information of childr en at admission including age,gender,past history,and medication history,etc.).Examine the calcium(Ca),phosphorus(P),alkaline phosphatase(ALP),bone-specificalkaline phosphatase(BAP),5 bone markers: procollagen type I N-terminal pept ide(PINP),Osteocalcin(OC),type I collagen carboxy-terminal peptide(CTX),p arathyroid hormone(PTH),25-hydroxyvitamin D(25-OH-D)and bone mineral de nsity before and after remission induction chemotherapy and compare the changesof the above indicators before and after remission induction chemotherapy.Results(1)General clinical data: 113 subjects were included in this study.Among them,65 were male children(57.5%)and 48 were female children(42.5%),with a male to female ratio of 1.35:1.The age distribution of newly dignosed was from 7 months to 14 years old,with a median age of 4 years.(2)There was no significant difference between gender and bone mineral density value and bone metabolism markers.(3)At the initial diagnosis,age was correlated with the abnormal value of ALP.The abnormal rates of ALP at 1-3 years old,4-6 years old and 7-14 years old were 44%,72.4%and 71.8%,and the difference was statistically significant(P<0.05).There was no significant difference in other indicators among age groups(P>0.05).(4)The BMD value at the newly dignosed was negatively correlated with BAP(r=-0.48,P<0.05),but not correlated with Ca,P,ALP,P1 NP,OC,CTX,PTH,25-OH-D(P>0.05).After remission induction treatment,there was no correlation between BMD-Z value and the above indicators(P>0.05).(5)Changes of general biochemical markers before and after remission induction chemotherapy: Ca and P all increased significantly after remission induction chemotherapy,with statistical differences(P<0.05).(6)Changes in bone metabolism regulation hormones before and after remission induction chemotherapy: PTH did not change significantly before and after remission induction chemotherapy,and the difference was not statistically significant(P>0.05).25-OH-D increased after remission induction therapy,and the difference was statistically significant(P<0.05).(7)Changes of bone turnover markers before and after remission induction chemotherapy: After remission induction chemotherapy,BAP increased,and ALP,P1 NP,OC,and CTX increased significantly,all of which had statistical differences(P<0.05).(8)Changes of bone mineral density-Z value before and after remission induction chemotherapy:There was no significant change in BMD value before and after remission induction chemotherapy,and the difference was not statistically significant(P>0.05).Conclusions:1.Before induction of remission,bone formation increased more rapidly in the 4-6year age group than in other age groups.2.Both bone formation and bone resorption of the children were accelerated after remission induction chemotherapy,suggesting that the rate of bone turnover is accelerated.3.There is no statistically significant change in bone mineral density before and after remission induction chemotherapy,but bone turnover markers are significant.Therefore the BMD alone cannot be used as a marker for evaluating bone quality. |
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