Obesity and insulin resistance in pediatric acute lymphoblastic leukemia worsens during maintenance therapy.
Obesity and insulin resistance in pediatric acute lymphoblastic leukemia worsens during maintenance therapy.
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DOI：
10.1002/pbc.24489
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发表时间：
2013-08
影响因子：
3.2
通讯作者：
Friedman, Debra L.
中科院分区：
文献类型：
--
作者：
Esbenshade, Adam J.;Simmons, Jill H.;Koyama, Tatsuki;Lindell, Robert B.;Friedman, Debra L.
关键词：
儿童急性淋巴细胞白血病（ALL）幸存者患代谢综合征（MS）的风险增加。为了建立积极治疗期间的发展轨迹，我们在维持治疗的第一年纵向随访了患者。在34例儿童ALL患者的前瞻性队列中，在ALL维持治疗的前12个月随访，我们评估了体重指数（BMI）、血压、空腹胰岛素和血糖、血脂、稳态代谢评估（HOMA）、瘦素和脂联素的变化。在研究期间，中位BMI z评分从0.29增加到0.66（p=0.001），中位空腹胰岛素水平从2.9 μU/ml增加到3.1 μU/ml（p=0.023），HOMA胰岛素抵抗（>3.15）患者比例从3%增加到24%（p=0.016）。中位瘦素从2.5 ng/ml增加到3.5 ng/ml（p=0.001），水平与BMI z评分相关。中位脂联素水平从18.0 μg/ml降至14.0 μg/ml（p=0.009），水平与BMI z评分呈负相关。未观察到中位总胆固醇和LDL水平的变化。中位甘油三酯降低（p<0.001），HDL有升高趋势（p=0.058）。尽管收缩期和舒张期高血压的总体患病率很高（分别为23.5%和26.4%），但血压没有显著变化。在ALL维持治疗的第一年对患者进行的随访表明，MS的组成部分随时间显著恶化。在此期间，应针对维持治疗期间限制BMI和胰岛素抵抗增加的预防性干预措施，以避免长期生存者中与MS相关的长期发病率。
Pediatric acute lymphoblastic leukemia (ALL) survivors are at increased risk for the metabolic syndrome (MS). To establish the trajectory of development during active treatment, we followed patients longitudinally over the first year of maintenance therapy. In a prospective cohort of 34 pediatric ALL patients, followed over the first 12 months of ALL maintenance, we evaluated changes in body mass index (BMI), blood pressure, fasting insulin and glucose, lipids, homeostatic metabolic assessment (HOMA), leptin and adiponectin. Over the study time period, the median BMI z-score increased from 0.29 to 0.66 (p=0.001), median fasting insulin levels increased from 2.9 μU/ml to 3.1 μU/ml (p=0.023), and the proportion of patients with insulin resistance by HOMA (>3.15) increased from 3% to 24% (p=0.016). Median leptin increased from 2.5 ng/ml to 3.5 ng/ml (p=0.001), with levels correlated with BMI z-score. Median adiponectin level decreased from 18.0 μg/ml to 14.0 μg/ml (p=0.009), with levels inversely correlated to BMI z-score. No change in median total cholesterol and LDL levels was observed. Median triglycerides decreased (p<0.001) and there was a trend to increase in HDL (p=0.058). Blood pressure did not significantly change, although overall prevalence of systolic and diastolic hypertension was high (23.5% and 26.4%, respectively). Following patients over the first year of ALL maintenance therapy demonstrated that components of the MS significantly worsen over time. Preventive interventions limiting increases in BMI and insulin resistance during maintenance therapy should be targeted during this time period to avoid long-term morbidity associated with the MS in long-term survivors.
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影响因子：
3.6
作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
10.1158/1055-9965.epi-09-0555
发表时间：
2010-01
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
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作者：
Meacham LR;Chow EJ;Ness KK;Kamdar KY;Chen Y;Yasui Y;Oeffinger KC;Sklar CA;Robison LL;Mertens AC
通讯作者：
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