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骨质疏松是强的松治疗的并发症,偶见于氯甲喋呤(MTX)治疗后。近来有文献报道急性淋巴母细胞性白血病(ALL)的头颅照射可减低骨骼生氏,亦可能引起骨质疏松。在常规骨X线片上只有骨质丢失30～50%以上才能检测出。作者用定量CT(QCT),一种精确测定骨小梁的脊椎骨密度(BD)技术,以检测病人是否存在骨质疏松。目的:(1)估计儿童期ALL存活者的BD,以了解骨质疏松的普遍性及严重性;(2)了解BD与ALL治疗时间和方法的关系。对象与方法42例儿童期ALL存活着,符合下列标准:(1)诊断ALL时小于18岁,未经治疗;(2)无持续2周以上的其它全身疾病;(3)按儿童肿瘤研究组(CCSG)常规方案治疗的;(4)BD研究前中止治疗至少6个月,一直体健,能随意活动,达完全缓解;(5)6个月内未用药物,包括维生素、钙或激素等;(6)第2颈椎以下或颈、胸、腹或性腺未作过放疗的。这些病儿在早期缓解后都鞘注MTX,每周1次,共4周。29例头颅放疗(20例18Gy,9例22.5～25.7GY);未放疗的13例在维持阶段,每12周鞘注MTX1次。测BD时已休止治疗6个月～11年,平均3年7个月。记录有关种族、年龄、骨龄、性别、身高、体重、体表面积、体格指数(体重/身高~2)及性发育资
Osteoporosis is a complication of prednisone treatment occasionally after methotrexate (MTX) treatment. Recently, it has been reported in the literature that cranial irradiation of acute lymphoblastic leukemia (ALL) can reduce osteogenesis and osteoporosis. In conventional bone X-ray film only bone loss of 30 to 50% or more to detect. The authors used quantitative CT (QCT), an accurate measure of trabecular bone mineral density (BD) to detect the presence or absence of osteoporosis in patients. Objectives: (1) To estimate the prevalence of BD in childhood ALL survivors to understand the prevalence and severity of osteoporosis. (2) To understand the relationship between BD and ALL treatment time and method. Subjects and Methods 42 cases of childhood ALL survived, meet the following criteria: (1) diagnosis of ALL less than 18 years of age, untreated; (2) no other systemic disease lasting more than 2 weeks; (3) According to the Children’s Cancer Research Group (CCSG) conventional regimen; (4) discontinuing treatment for at least 6 months prior to BD study, continuing to be healthy and able to move freely to achieve complete remission; (5) no medications, including vitamins, calcium, or hormones, Etc .; (6) below the second cervical spine or neck, thorax, abdomen or gonads did not make radiotherapy. These children were intrathecally injected with MTX after early remission, once a week for 4 weeks. 29 cases of cranial radiotherapy (20 cases of 18Gy, 9 cases of 22.5 ~ 25.7GY); 13 cases of non-radiotherapy in the maintenance phase, intrathecal injection of MTX every 12 weeks. Measuring BD has been discontinued treatment of 6 months to 11 years, an average of 3 years and 7 months. Record information on race, age, bone age, sex, height, weight, body surface area, body mass index (weight / height ~ 2)