中文摘要：

目的探讨急性白血病（AL）患儿柔红霉素（DNR）化疗致心肌损害时血清硫化氢（H2S）水平变化。方法2008年10月一2011年6月小院儿童血液科住院的AL患儿共159例，中位年龄7岁。均行含DNR方案化疗，采用敏感硫电极法测定其化疗前后血清H2S水平变化，分析在不同DNR累积剂量时心肌细胞损害与H2S的关系。结果随着DNR累积剂量的增加，心肌损害的发生牢亦随之增高（P。〈0．05），血清H2S水平亦随之增加。中剂量组患儿血清H2S水平较低剂量组升高，差异有统计学意义（P〈0．05）；而高剂量组血清H2S水平较中剂量组进一步升高，差异有统计学意义（P〈0．01）。心肌损害组血清H2S水平较无心肌损害组显著升高，差异有统计学意义（P〈0．01）。对心肌损害组和无心肌损害组血清H2S水平进行ROC曲线分析，ROC曲线下面积为0．929（95％C10．8571．000）。以假阳性率（1一特异性）2．8％为诊断点，血清H2S诊断心肌损害的诊断点为128．09Ixmol·L-1，以此诊断的敏感性为83．3％，特异性为97．2％。对心肌损害患儿进行回顾性分析发现，DNR剂量达中剂量以上心肌细胞尚未受损时，其血清／H2S水平已显著升高。以128．09Ixmol·L-1为临界点，血清H2S水平升高的患儿其进一步化疗心肌损害的发生率亦显著升高。结论血清H2S水平可反映心肌细胞的损害程度，是早期监测心肌细胞受损的有效指标。

英文摘要：

Objective To investigate the changes of serum hydrogen sulfide （H2S） in acute leukemia （AL） children with daunorubicin （DNR） - induced myocardial damage. Methods From Oct. 2008 to Jun. 2011 , one hundred and fifty - nine cases of AL children were en- rolled in this study at Beijing Shijitan Hospital. The median age was 7 years. All these children received DNR - containing regimen chemothe- rapy. Serum levels of H2 S were measured before and after chemotherapy, and the correlation between different cumulative doses of DNR and H： S levels were analyzed. Results As the cumulative dose of DNR increased, the incidence of myocardial damage increased （ P 〈 0.05 ） , and the serum levels of H2S also increased. Levels of H2S of middle - dose children increased significantly than those in the low - dose （P 〈 0.05 ） ; and levels of H2 S in high - dose group increased further than those in middle - dose group （P 〈 0.01 ）. Levels of H2 S in children with myocardial damage increased obviously than those without myocardial damage, and the difference was significant （P 〈 0.01 ）. Furlbm＇more, ROC analysis showed the area under ROC crave was 0. 929 （95% C10. 857 - 1. 000） , take false positive rate （ 1 - specificity）2.8% as the diagnosis of point,the optimum cut - off value of H2S was 128.09 Ixmol . L-1 , and the sensitivity and specificity were 83.3% and 97.2%, respectively. Retrospective analysis showed that the AL children with myocardial damage and those with over middle - dose DNR chemothera- py but without myocardial damage had higher levels of H2S. Taking as the optimum cut - off value, the higher the H2S level was, the higher mortality of myocardial damage would be. Conclusion Serum levels of H2 S in children with AL can reflect the extent of myocardial damage, and it would be an effective indicator for early detection of myocardial cell damage.