Estudo da permeabilidade intestinal em pacientes leucêmicos antes da quimioterapia

Abstract

Leukemias are diseases characterized by neoplastic proliferation that can affect the entire bone marrow, preventing hematopoiesis and causing abnormalities in peripheral blood. Sometimes leukemias not only affect the hematopoietic system, but also other organs andtissues, including the small intestine. Changes in barrier function of the intestinal mucosa have been observed in patients with leukemia before chemotherapy induction. It is assumed that these changes may be associated with dysfunction of immunocompetent cells, the leukemic cell infiltration in digestive tract, or even the action of local cytokine secretion in these patients. The objective of this study was to evaluate the intestinal barrier function in leukemia patients before the start of the chemotherapy through a intestinal permeability test, using lactulose and mannitol as markers. The study included 20 patients diagnosed with leukemia (acute and chronic). The intestinal permeability test was performed beforechemotherapy. Ten healthy volunteers were also submitted to the test. In the first group, the median lactulose/mannitol ratio was 0,019, whereas in healthy controls the median was 0,009 (p = 0,244). A comparison was also performed between acute leukemia patients and healthy volunteers. The median lactulose/mannitol ratio in acute leukemia patients was 0,034 and, when compared to healthy controls (TL/M = 0,009), disclosed a p value of 0,069. This same comparison was made between acute myeloid leukemia patients and healthy controls, with a p value of 0,149. The p value disclosed by the comparison of intestinal permeability between acute and chronic leukemia patients was 0,098. We also studied the possible interference of gastrointestinal symptoms and fever presents in the intestinal permeability tests, but statistical significance was not show, neither in the entire sample (p value of 0,396 and 0,270,respectively) nor in acute leukemia (0,491 and 0,315). We concluded that the intestinal barrier function measured by intestinal permeability test was similar in leukemic patients in general and healthy controls, but a tendency towards a different behavior was found in the intestinalbarrier function in the acute leukemia group. Intestinal permeability test also did not differ between acute and chronic leukemia (p = 0,098), even though the median in the first group was shown to be five times higher. Gastrointestinal symptoms and fever did not interfere with intestinal permeability test values in leukemia patients in general and in acute leukemiapatients.