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  • Title: Cortisol level as risk factor for malignant hematologic pathology in children exposed to ionizing radiation after Chornobyl accident.
    Author: Bebeshko VG, Bruslova KM, Pushkareva TI, Tsvietkova NM, Lyashenko LO, Sergeeva AS, Kuzmenko VF, Iatsemyrskiy SM, Samson YM, Boyarsky VG, Tryhlіb IV.
    Journal: Probl Radiac Med Radiobiol; 2017 Dec; 22():306-315. PubMed ID: 29286515.
    Abstract:
    OBJECTIVE: Determination of serum cortisol level in the initial period of acute leukemia in children, who exposed to ion izing radiation and other factors of Chornobyl accident, depending on their age and prognosis of disease. MATERIALS AND METHODS: The study involved 283 children residents of Kyiv, Zhytomyr and Chernihiv regions. There were 90 acute leukemia patients(AL) (ALL - 56, AML - 34), and 193 people of comparison group with anemia, leukemoid reactions and lymphadenopathy. We analyzed the type of comorbid somatic pathology, diseases in the genealogy, hematological parameters, cortisol levels in blood serum and irradiation doses in all children. In patients with AL expected median survival was calculated. RESULTS: In 28.9 % of AL children the initial cortisol content was below 200 nmol/l, in 7.8 % - higher than 500 nmol/l (in the comparison group 10.4 % and 17.1 % respectively). Among AL patients with cortisol levels below 200 nmol/l were significantly less amount of persons with chronic bacterial infections and persistent viral infections (CMV, EBV) and in the genealogy of these children allergic reactions, endocrine pathology diagnosed more often compared with patients, whose hormone levels was higher than 200 nmol/l (p < 0.05). Distribution of children from control group by gradations of cortisol, age groups, defined somatic pathology and diseases in genealogy had no difference. It is shown, that lower initial blood serum cortisol level in ALL children correlates to a greater probability of relapse (Rs = -0,67). In patients with AML a direct correlation between cortisol level and median survival was detected (Rs = 0,79). Children radiation doses were ranging from 0.08 mSv to 14.9 mSv, and there were slightly higher among residents of Zhytomyr region (8.4 ± 1.2 mSv) compared to other regions. However, these doses did not affect blood serum cortisol levels in children and the course of AL. CONCLUSIONS: These data suggest the need for correction and individualization of corticosteroid doses for optimization of AL patients treatment. Children, who have lower than normative serum cortisol levels are at increased risk of hema tologic pathology and they need for hematologic monitoring. Meta. Vyznachennia rivniv kortyzolu syrovatky krovi v initsial'nyy̆ period gostrykh ley̆kemiy̆ u ditey̆, iaki zaznaly vplyvu ionizuiuchogo vyprominiuvannia ta inshykh chynnykiv avariï na ChAES, zalezhno vid viku i prognozu perebigu zakh voriuvannia.Materialy i metody. Obstezheno 283 dytyny, zhyteliv Kyïvs'koï, Zhytomyrs'koï ta Chernigivs'koï oblastey̆. Z gostroiu ley̆kemiieiu (GL) bulo 90 khvorykh (gostroiu limfoblastnoiu ley̆kemiieiu – 56, gostroiu miieloblastnoiu ley̆ kemiieiu – 34), 193 osoby z anemiiamy, ley̆kemoïdnymy reaktsiiamy i limfadenopatiiamy sklaly grupu porivniannia. U vsikh ditey̆ analizuvaly vyd komorbidnoï somatychnoï patologiï, zakhvoriuvannia v rodovodi, gematologichni pokaznyky, riven' kortyzolu v syrovattsi krovi ta dozy oprominennia. U khvorykh na GL rozrakhovuvaly medianu vyzhyvanosti. Rezul'taty. U 28,9 % ditey̆ z GL initsial'nyy̆ vmist kortyzolu buv nyzhchyy̆ za 200 nmol'/l, u 7,8 % – vyshchyy̆ za 500 nmol'/l (v grupi porivniannia 10,4 ta 17,1 %, vidpovidno). Sered khvorykh na GL z rivnem kortyzolu nyzhchym za 200 nmol'/l bulo dostovirno menshe osib z khronichnymy bakterial'nymy infektsiiamy ta persystuiuchymy virusnymy infektsiiamy (tsytomegalovirus, virus Epshtey̆na Barr) i u rodovodi tsykh ditey̆ chastishe diagnostuvalys' alergichni reaktsiï ta endokrynna patologiia, porivniano z khvorymy, u iakykh riven' gormonu perevyshchuvav 200 nmol'/l (r < 0,05). Rozpodil ditey̆ grupy porivniannia za gradatsiiamy kortyzolu, vikovymy grupamy, vyznachenoiu somatychnoiu patologiieiu i khvorobamy u rodovodi riznytsi ne mav. Pokazano, shcho nyzhchyy̆ riven' initsial'nogo kortyzolu v syro vattsi krovi ditey̆ z gostrymy limfoblastnymy ley̆kemiiamy koreliuie z bil'shoiu virogidnistiu rozvytku retsydyvu zakhvoriuvannia (Rs = –0,67). U khvorykh na gostru miieloblastnu ley̆kemiiu vstanovlena priama koreliatsiy̆na za lezhnist' mizh rivnem kortyzolu i medianoiu vyzhyvanosti (Rs = 0,79). Dozy oprominennia ditey̆ znakhodylysia v me zhakh vid 0,08 do 14,9 mZv, i buly deshcho vyshchymy u zhyteliv Zhytomyrs'koï oblasti (8,4 ± 1,2 mZv) porivniano z inshy my regionamy. Odnak zaznacheni dozy ne vplyvaly na riven' kortyzolu v syrovattsi krovi u ditey̆ ta perebig GL. Vysnovky. Otrymani dani svidchat' pro neobkhidnist' korektsiï ta indyvidualizatsiï doz kortykosteroïdnykh prepa rativ u khvorykh na GL z metoiu optymizatsiï likuvannia. Dity, u iakykh riven' syrovatkovogo kortyzolu nyzhchyy̆ za nor matyvnyy̆, stanovliat' grupu pidvyshchenogo ryzyku z onkogematologichnoï patologiï i potrebuiut' gematologichnogo monitoruvannia.
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