Rationale treatment and preventive measures for correction of bone structure in children with acute leukemia, exposed to ionizing radiation due to the Chornobyl accident

Objective. To justify and evaluate the effectiveness of treatment and preventive measures taken to correct the bio-chemical and biophysical changes in the structure of bone in children exposed to ionizing radiation due to Chornobyl accident in the dynamics of leukemic process. Materials and methods. The study involved 144 patients with acute lymphoid and myeloid leukemia. Serum calcium, total protein, alkaline phosphatase, cortisol and thyroid-stimulating hormone were investigated, as well as calcium and phosphate excretion, amino acids composition in the urine, acid-base balance and buffer systems of blood, bone density. Results. A reduction of bone densitometry, calcium and cortisol levels and increase of serum alkaline phosphatase and urine oxyproline were found in children with acute leukemia in acute I phase and during the chemotherapy. In the period of remission the majority of patients did not differ from the comparison group. The signs of osteopenic syndrome that require monitoring of the bone structure status were revealed in 10.0 % of children of the comparison group. Radiation doses of leukemia patients were 3.66 ± 0.11 mSv. No relationship between radiation dose and indicators that reflect the state of the bone tissue structures has been established. The use of complex health care measures in children with acute leukemia in remission, contributed to the positive effect of 62.0 %. Worser effect was observed in patients with an unfavorable course of the disease. Conclusions. Results of the study of bone tissue metabolism prove fore a change in the organic and mineral matrix in patients with acute leukemia exposed to ionizing radiation as a result of the Chonobyl NPP accident, and persons without hematologic diseases, and the need for treatment and prevention.Meta. Obg'runtuvaty ta ocinyty efektyvnist' likuval'no-profilaktychnyh zahodiv, zastosovanyh dlja korekcii' biohimichnyh i biofizychnyh zmin v strukturi kistkovoi' tkanyny u ditej, jaki zaznaly vplyvu ionizujuchogo oprominennja vnaslidok avarii' na ChAES, v dynamici lejkemichnogo procesu. Materialy i metody. Obstezheno 144 ditej, hvoryh na gostri limfota mijeloblastni lejkemii'. Doslidzhuvaly dozy oprominennja hvoryh, vmist kal'ciju, zagal'nogo bilku, luzhnoi' fosfatazy, kortyzolu i tyreotropnogo gormonu gipofizu v syrovatci krovi, kyslotno-luzhnu rivnovagu, ekskreciju fosfativ kal'ciju, sklad aminokyslot v sechi, shhil'nist' kistkovoi' tkanyny. Rezul'taty. U ditej z gostrymy lejkemijamy v I gostryj period ta pry provedenni himioterapii' vyjavleno znyzhennja pokaznyka densytometrii' kistok, rivnja kal'ciju, kortyzolu ta pidvyshhennja luzhnoi' fosfatazy v syrovatci krovi i oksyprolinu v sechi. V period remisii' zahvorjuvannja u bil'shosti hvoryh pokaznyky ne rozriznjalys' z grupoju porivnjannja. U 10,0 % ditej grupy porivnjannja vidmichajut'sja projavy osteopenichnogo syndromu. Dozy oprominennja hvoryh na gostri lejkemii' stanovyly 3,66 ± 0,11 mZv. Ne vstanovleno zv'jazku mizh dozamy oprominennja ta pokaznykamy, jaki harakteryzujut' stan struktury kistkovoi' tkanyny, i medianoju vyzhyvanosti hvoryh. Zastosuvannja kompleksu likuval'no-profilaktychnyh zahodiv u ditej, hvoryh na gostri lejkemii' v period remisii', spryjalo pozytyvnomu efektu u 62,0 %. Girshyj efekt sposterigavsja u pacijentiv z nespryjatlyvym perebigom zahvorjuvannja. Vysnovky. Rezul'taty doslidzhennja pokaznykiv metabolizmu kistkovoi' tkanyny svidchat' pro najavnist' zmin v organichnomu ta mineral'nomu matryksi jak u hvoryh na gostri lejkemii', jaki zaznajut' vplyvu ionizujuchogo oprominennja vnaslidok avarii' na ChAES, tak i osib bez onkogematologichnoi' patologii', ta neobhidnist' zastosuvannja likuval'no-profilaktychnyh zahodiv.