儿童神经母细胞瘤化疗前后免疫功能指标分析

目的观察神经母细胞瘤（neuroblastoma，NB）患儿化疗前后免疫功能指标的变化，并探讨其，临床意义，为进行NB化疗的免疫调节和支持治疗提供依据。方法选择我院自2007年1月至2009年2月收治的NB患儿，分别检测血清中免疫球蛋白（IgG、IgA、IgM、IgE）和血液中细胞免疫，包括总T淋巴细胞（TTL，CD3＋，CD19-），T辅助淋巴细胞（THL，CD3＋，CD4＋），T抑制淋巴细胞（TSL，CD3＋，CD8＋）、NK细胞（CD3-，CD16＋／CD56＋）百分比及辅助／抑制T细胞（CD4＋／CD8＋）比率。结果患儿化疗前体液免疫水平基本正常，细胞免疫功能低于正常。化疗后体液免疫IgG、IgA、IgM、IgE均较化疗前降低。细胞免疫中，TTL、CD4＋／CD8＋较化疗前下降，而THL、TSL、NK细胞较化疗前升高。有统计学差异（P〈0．05）。结论联合化疗会造成NB患儿体液及细胞免疫功能紊乱，监测T细胞亚群水平及Ig系列对评估患者细胞及体液免疫功能，以及应用免疫调节和支持治疗，以减少化疗后感染机会，提高生活质量有积极的意义。

Analysis of Immune Function in Children with Neuroblastoma

Objective To observe immune function in children with neuroblastoma （NB） before and after chemotherapy, to explore its clinical significance and provide the basis for immunomodulatory and supportive therapy in the NB chemotherapy. Methods This study enrolled children with NB treated in our hospital from January 2007 to February 2009. We detected the percentage of immunoglobulin （IgG, IgA, and IgM, IgE） in serum and cellular immunity including total T lymphocytes （TFL, CD3- and CD19 - ）, T helper lymphocytes （THL, CD3 ＋ and CD4 ＋ ）, T suppressor lymphocytes （TSL, CD3 ~ and CD8 ＋ ） , NK cells （CD3- , CD16 ＋/CD56 ＋ ） , and the ratio of CD4 ＋ and CD8 ＋ （CD4 ＋/CD8 ＋ ） . Results The level of humoral immunity was normal and the cellular immune function was lower than normal before chemotherapy. But the humoral immunity was decreased after chemotherapy. TI＇L and CD4 ＋/CD8＋ were decreased, and the THL, TSL, as well as NK cells were increased after chemotherapy with significant differences （P 〈 0.05）. Conclusions Combined chemotherapy can cause humoral and cellular immune dysfunction in children with NB. It is necessary to monitor T cell subsets and Ig series for assessment of cellular and humoral immune function for application of immune regulation and supportive treatment, which is helpful to reduce infection during chemotherapy and improvement the quality of life in patients with NB.