视网膜母细胞瘤患儿初次诊断时免疫功能分析  

Immunity conditions analysis of retinoblastoma in children at preliminary diagnosis

作　　者：赵文[1] 金眉[1] 巩文玉[1] 张大伟[1] 李兴军[1] 张诚玥[2] 刘曙光[1] 赵军阳[2] 马晓莉[1] 

机构地区：[1]儿童血液病与肿瘤分子分型北京市重点实验室、儿科学国家重点学科、儿科重大疾病研究教育部重点实验室、首都医科大学附属北京儿童医院血液肿瘤中心,100045 [2]首都医科大学附属北京儿童医院眼科,100045

出　　处：《中华实用儿科临床杂志》2016年第24期1894-1897,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家财政部公益性行业科研专项（2014040）;北京市医院管理局临床医学发展专项经费资助（ZY201404）

摘　　要：目的观察视网膜母细胞瘤（RB）患儿初次诊断时免疫功能状况，探讨相同年龄段、不同临床分期、单双眼RB患儿是否存在免疫水平的差异，为进行RB的免疫调节和支持治疗提供依据。方法选择2011年1月至2014年6月在首都医科大学附属北京儿童医院血液肿瘤中心收治的84例RB患儿，RB的诊断标准、分期及临床危险度分组均参照RB国际分类系统。检测患儿血清免疫球蛋白（IgG、lgA、IgM）和血液中细胞免疫，包括总T淋巴细胞、辅助性T淋巴细胞、抑制性T淋巴细胞、自然杀伤细胞百分比及辅助性T淋巴细胞／抑制性T淋巴细胞比率（C1M^＋／CD8^＋）。结果（1）体液免疫方面：〈1岁者IgA水平较正常明显下降（〈0．0667g／L），随着年龄增长，IgA水平逐渐恢复至正常，免疫球蛋白水平与患儿年龄、临床分期、单双眼受累差异无统计学意义。（2）细胞免疫方面：不同临床分期中，单眼：〈1岁及〉3岁患儿E期较A-D期CD4^＋／CD8^＋明显下降，差异有统计学意义（P=0．033、0．031）；双眼：1～3岁和〉3岁患儿E期较A-D期CD4^＋／CD8’明显下降，差异有统计学意义（P=0．026、0．046），1-3岁患儿E期较A-D期辅助性T淋巴细胞明显下降，差异有统计学意义（P=0．040）。相同临床分期：〉3岁患儿E期双眼较单眼CIM^＋／CD8^＋下降，差异有统计学意义（P=0．027）。结论RB患儿免疫功能有变化，特别是细胞免疫水平，可能与发病、病情进展有关；监测T淋巴细胞亚群水平，对判断预后和指导使用相应免疫调节药物有指导意义。Objective To observe the immunity conditions of children with retinoblastoma （RB） at prelimina- ry diagnosis, and to explore the differences in immunity levels among children with RB at the same age period but at different clinical stages or with unilateral or bilateral RB, in order to provide basis for the immune regulation and support of RB. Methods Childhood RB patients were selected from those admitted to the hematologic tumor center of Beijing Children＇s Hospital,Capital Medical University from January 2011 to June 2014 were selected. RB International In- traoeular Retinoblastoma Classification was used as the standard of diagnosis, staging and clinical risk. The percentages of serum immunoglobulin （ IgG, IgA and IgM ） and cellular immunity indexes including total T - lymphoeytes, helper T- lymphocytes （THL） and suppressor T- lymphocytes（TSL） ,natural killer ceils were tested,and the ratio between THL and TSL （ CD4^＋/CD8^＋ ） were also determined. Results （ 1 ） The humoral immunity showed no significant diffe- rence in Ig levels among RB children in different clinical stages and unilateral or bilateral RB, and those with same clinical stage and unilateral or bilateral RB. The IgA level in patients younger than 1 year old was significantly lower than that of the normal children （ 〈 0. 066 7 g/L） , but they returned to the normal level along with age increasing. （2） In cellular immunity, among different clinical stage, unilateral RB ： CD4^＋/CD8^＋ ratio of E stage was significantly lower than that of A - D stages among 〈 1 year old and 〉 3 years old children patients at the same age （ P = 0. 033 ,0. 031 ） ; bilateral RB ： CD4^＋/CD8^＋ ratio of E stage was significantly lower than that of A - D stages in 1 to 3 years old and 〉 3 years old children patients at the same age （ P = 0. 026,0. 046 ）. The THL level of E stage was significantly lower than that of A - D stages in 1 - 3 years old children patients with bilateral RB （ P = 0. 040 ）. In the

关 键 词：视网膜母细胞瘤 初次诊断 免疫指标 

分 类 号：R739.7[医药卫生—肿瘤]