[The condition of lipid metabolism in patients with newly diagnosed acute leukemia.]

The article presents comparative analysis of lipid metabolism in patients with acute leukemia depending on form of disease, age, occurrence of cardiovascular pathology and infectious complications. The study sampling included 148 patients with primarily diagnosed acute leukemia aged from 16 to 79 years (average age is 54 years). The control group consisted of 28 healthy volunteers aged from 26 to 75 years (average age is 49 years). The distribution by age in this group corresponded to distribution in group of patients (p>0.05, khi-square). It is established that under acute promyelocyte leukemia indicators of lipid metabolism are subjected to minimum alterations because only concentration of high density lipoproteins reliably decreased. In case of other forms of acute myeloid leukemia and acute lymphoblastic leukemia significant alterations of lipid specter of blood occur characterized by decreasing of content of cholesterol, high and low density lipoproteins and apolipoprotein A1.Also it was established that these alterations have no dependence on age of patients in contrast with healthy individuals having direct dependence of level of cholesterol and high and low density lipoproteins on age. The occurrence of concomitant cardiovascular pathology in patients with acute leukemia had no effect on indicators of lipid metabolism. The occurrence of infectious complications during period of manifestation of acute leukemia enhances shifts in indicators of lipid transport system in direction of decreasing of levels of cholesterol and high and low density lipoproteins.

[The evaluation of sensitivity and specificity of technique of detection of C-reactive protein under diagnostic of infectious complications in patients with acute lymphoblastic leucosis receiving chemotherapy].

The C-reactive protein is a generally recognized marker of inflammation and bacterial infection. However, issue of diagnostic effectiveness of this indicator is still open-ended in case of patients with oncologic hematological diseases. The level of C-reactive protein can increase under neoplastic processes. On the contrary, the inhibition of immune response observed under cytoplastic therapy can decrease synthesis of this protein. The study was organized to establish levels of C-reactive protein as markers of infection in adult patients with acute lymphoblastic leucosis under application of chemotherapy and to evaluate their diagnostic effectiveness. The sampling included 34 patients with acute lymphoblastic leucosis all patients had infectious complications at various stages of treatment. The levels of C-reactive protein in groups of patients with localized infections (mucositis, abscess, pneumonia, etc.) or fever of unknown genesis had no statistical differences but were reliably higher in patients without infectious complications. The concentrations of C-reactive protein in patients with syndrome of systemic inflammatory response and sepsis had no differences. At the same time, level of C-reactive protein under systemic infection (syndrome of systemic inflammatory response, sepsis) was reliably higher than in case of localized infection. The diagnostically reliable levels of C-reactive protein were established as follows: lower than 11 mg/l--infectious complications are lacking; higher than 11 mg/l--availability of infectious process; higher than 82 mg/l--generalization of infection. The given levels are characterized by high diagnostic sensitivity (92% and 97% correspondingly) and specificity (97% and 97%) when patients receive therapy without application of L-asparaginase. At the stages of introduction of this preparation effecting protein synthesizing function of liver sensitivity of proposed criteria are decreased (69% and 55% correspondingly). However; due to high specificity (100% and 96%) their diagnostic effectiveness remains high.

[The condition of endothelium and hemostasis in patients with primary diagnosed acute lymphoblast leucosis].

The evaluation of state of endothelium and plasma hemostasis, thrombocytopenia degree, rate of thrombo-hemorrhagic complications in adult patients with acute lymphoblastic leucosis in the period of disease manifestation was made. The thrombosis developed in 1 out of 24 (4.2%) examined patients, hemorrhagic syndrome in 11 out of 24 (45.8%) examined patients. The last case is closely linked with severity of thrombocytopenia occurred in patients with number of thrombocytes less than 50 x 109/l. At the same time, high correlation between number of leukemic cells and level of B-dimers (rs = 0.703) testifies that the leucosis process activates intravascular thrombus formation. The higher content of B-dimers in 100% of patients validates this assumption. The high levels of soluble thrombo-modulin and von Willebrand factor indicate the loss of thromboresistance by vessel endothelium and the activation of prothrombin mechanisms. The statistically valid coefficients of correlation between concentrations of thrombomodulin and D-dimers (rs = 0.598) and the level of von Willebrand factor and severity of hemorrhagic syndrome prove that disorders of blood coagulation under acute lymphoblast leucosis occur with active involvement of endothelium.