| ObjectiveAnemia in cancer patients is usually related to bone marrow infiltration of tumor cells or bone marrow suppression caused by chemotherapy,but some patients still have various degrees of anemia during tumor in remission or without chemotherapy.This article aims to explore the changes in levels of erythropoietin(EPO)and tumor necrosis factor alpha(TNF-?)in children with cancer-related anemia(CRA)to clarify the application of erythropoiesis stimulating agents(ESAs)and the effect of TNF-?on EPO;analyze relevant factors of the onset in CRA to guide the prevention and treatment of anemia.Methods1.Selected patients(n=108)from May 2018 to December 2019 in the Department of Hematology Pediatrics of the Affiliated Hospital of Qingdao University.Total patients were divided into four groups:anemic tumor group(n=42,including 21 cases of non-remission and 21 cases in remission),non-anemic tumor group(n=33,including 16cases of non-remission and 17 cases in remission),anemic non-tumor group(n=18,including non-neoplastic disease such as IDA)and healthy control group(n=15,healthy children).The chemiluminescence method was used to detect the serum levels of EPO and TNF-?of all cases.2.Recorded the basic demographic information of cases such as gender and age,and collected case data and some laboratory test results including blood routine,C-reactive protein(CRP),bone marrow(BM)puncture,biochemical examinations,etc.Relevant factors of anemia were analyzed by using Logistic regression.Results1.Changes of serum EPO levels in different groups(1)There was a statistically significant difference in serum EPO levels between four groups(F=13.25,P<0.05).Serum EPO levels in anemic tumor group[(341.73±314.00)IU/L]and anemic non-tumor group[(235.26±312.23)IU/L]were significantly higher than that in non-anemic tumor group[(86.00±14.62)IU/L]and healthy controls[(32.78±45.12)IU/L](P<0.05);there was no statistically significant difference in EPO levels between anemic tumor group and anemic non-tumor group.Neither non-anemic tumor group nor healthy controls(all P>0.05).(2)In anemic tumor group,there was no statistically significant difference in EPO levels between remission cases[(334.55±355.73)IU/L]and unremissioned cases[(344.27±304.20)IU/L](t=0.09,p>0.05).2.Changes in peripheral blood Hb levels in different groups(1)There was a statistically significant difference in peripheral blood Hb levels between four groups(F=32.24,P=0.00).Hb levels in anemic group[anemic tumor group(77.83±15.01)g/L and anemic non-tumor group(73.00±20.95)g/L]was significantly lower than that in non-anemic group[non-anemic tumor group(121.55±9.31)g/L and healthy controls(126.12±5.67)g/L](all P<0.05);there was no difference in Hb levels between anemic tumor group and anemic non-tumor group.Neither non-anemic tumor group nor healthy controls(all P>0.05).(2)In tumor anemia group,there is no statistically significant difference in Hb levels between remission cases[(79.45±13.85)g/L]and unremissioned cases[(73.27±18.000)g/L](t=0.12,p>0.05).3.Correlation analysis of serum EPO levels and Hb in different groups(1)Serum EPO levels in tumor anemic group and anemic non-tumor group were negatively correlated with Hb(r=-0.53 and-0.69,all p<0.05);There was no significant correlation between serum EPO levels and Hb in non-anemic tumor group and healthy controls(r=0.06 and-0.05,all p>0.05).(2)The regression equation of lgEPO and Hb in anemic tumor group:lgEPO=3.85-0.02Hb(R~2=0.62,p<0.05),O/P 0.95±0.28;the regression equation of lgEPO and Hb in anemic non-tumor group:lgEPO=4.54-0.03Hb(R~2=0.69,p<0.01),O/P 0.97±0.22;there was no significant difference in O/P between anemic tumor group and anemic non-tumor group(t=0.54,p>0.05).4.Changes of serum TNF-?levels in different groups(1)There was a statistically significant difference in serum TNF-?levels between four groups(F=9.16,P<0.05).Levels of serum TNF-?in anemic tumor group[(11.64±9.19)pg/mL]were significantly higher than that of non-anemic tumor group[(4.22±2.52)pg/m L]and healthy controls[(3.16±0.75)pg/m L](all P<0.05).There was no statistically significant difference in serum TNF-?levels between non-anemic tumor group and healthy controls(P>0.05).(2)In anemic tumor group,serum TNF-?levels of unremissioned cases[(15.92±10.60)pg/mL]were significantly higher than that of remission cases[(6.52±2.54)pg/m L](t=2.73,p<0.05).5.Correlation analysis of serum TNF-?levels and Hb in different groups(1)Serum TNF-?levels in anemic tumor group were negatively correlated with Hb(r=-0.48,p<0.05);there was no significant correlation between serum TNF-?levels and Hb in non-anemic tumor group and healthy controls(r=-0.04 and-0.09,all p>0.05).(2)In anemic tumor group,serum TNF-?levels in remission cases had no significant correlation with Hb(r=0.07,p>0.05);serum TNF-?levels in unremissioned cases were negatively correlated with Hb(r=-0.57,p<0.05).6.Correlation analysis of serum TNF-?levels and EPO in different groups(1)There was no significant correlation between serum TNF-?level and EPO or O/P in anemic tumor group(r=-0.08 and-0.06,all p>0.05);there was no obvious correlation between TNF-?levels and EPO in non-anemic tumor group and healthy controls(r=-0.10 and-0.05,all p>0.05).(2)In anemic tumor group,there was no significant correlation between serum TNF-?levels and EPO or O/P in remission and unremissioned cases(r=-0.04 and-0.05,r=-0.10 and-0.07,all p>0.05).7.Univariate analysis was performed on the data of 42 cases of anemic tumor group and 33 cases of non-anemic tumor group:there were differences in the albumin,WBC,CRP and late erythroblasts ratio in BM(P was relaxed to<0.1);Taking the above data as independent variables into Logistic regression showed that WBC and late erythroblasts ratio in BM were relevant factors for the onset of CRA(all P<0.05).The reduced WBC count was a risk factor(OR=6.40)and increased ratio of late erythroblasts in BM was a protective factor(OR=0.02).Data analysis was performed on cases with reduced WBC in the anemic tumor group(20 remission cases and 14 unremissioned cases):13 cases were infected and granulocyte growth of 3 cases in BM was reduced.Data analysis was performed on the cases of increased ratio of late erythroblasts in BM in the anemic tumor group(14 remission cases in and 8 unressioned cases)and erythroid growth of all cases in BM was active.Conclusion1.Levels of EPO in tumor with or without remission were elevated,suggesting that serum EPO levels in children with CRA may not be affected by tumor burden.2.There was no significant difference in EPO levels between anemic tumor group and anemic non-tumor group,suggesting that the ability of EPO to regulate anemia in CRA of children could be normal.3.In anemic tumor group,serum TNF-?levels of unremissioned cases were significantly higher than that of remission cases,suggesting that serum TNF-?levels in children with CRA may be affected by tumor burden.4.There is no significant correlation between TNF-?and EPO in tumor with or without remission,suggesting that the mechanism that how TNF-?participated in anemia may not be related to the inhibition of EPO production in children with CRA.5.Anemia in children with tumors was relevant with WBC counts and the ratio of late erythroblasts in BM,suggesting that anemia may be related to the suppression of bone marrow hematopoietic function in children with CRA. |
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