112例恶性实体肿瘤患儿的淋巴细胞谱及化疗后改变分析

Analysis of lymphocyte spectrum of 112 pediatric patients with malignant solid tumors and changes after chemotherapy

目的探讨恶性实体肿瘤患儿的总淋巴细胞、淋巴细胞亚群绝对计数及相对比例,并观察化疗对其影响。方法回顾性分析112例初诊恶性实体肿瘤患儿资料,在首次及第二轮化疗开始前采集患儿外周静脉血,检测血常规、免疫球蛋白、淋巴细胞亚群分型及绝对数量。结果实体瘤患儿初发时出现各种类型的淋巴细胞低下,最多的表现为CD8+T淋巴细胞数量低下(36.3%),其次是CD4+淋巴细胞减少(31.1%);在不同种类实体瘤患儿之间进行比较,差异无统计学意义(P=0.08)。与淋巴数值正常的患儿比较,初始淋巴细胞下降的儿童化疗后易于发生严重感染(19.1%与5.9%,P<0.01),主要是神经母细胞瘤患儿中差异显著(23.9%与6.4%,P<0.01)。实体瘤患儿化疗后淋巴细胞数目显著降低,尤其是CD4+及CD19+淋巴细胞(P<0.01),CD4/CD8比值下降显著(P<0.01)。结论与健康儿童相比,实体瘤患儿淋巴细胞低下的比例较高;第一轮化疗即可导致患儿淋巴细胞计数显著下降,化疗对B淋巴细胞及CD4+淋巴细胞杀伤明显,对体液免疫的影响较早出现。重视辅助淋巴细胞增殖和体液免疫的补充可能有助于减少化疗后感染。

Objective To explore the absolute counts and relative proportion of total lymphocyte count and lymphocyte subsets of pediatric patients with malignant solid tumors and observe the effects of chemotherapy. Methods Clinical data of 112 pediatric patients with malignant solid tumors were retrospectively analyzed. The peripheral venous blood was collected before ftrst and second course of chemotherapy and blood routine indexes, immunoglobulin, absolute count of lymphocyte, and lymphocyte subtypes were detected. Results Various types of lymphopenia appeared when pediatric patients developed solid tumors for the first time. The major types were CD8 ＋ lymphopenia （36.3%） and CD4 ＋ lymphopenia （31.1%）. The differences of pediatric patients with different types of solid tumors were not statistically significant （P=0.08）. Compared with pediatric patients with normal lymphocyte counts, pediatric patients with lymphopenia were prone to severe infections after chemotherapy （19.1% vs 5.9%, P〈0.01）, especially for pediatric patients with neurohlastoma （23.9% vs 6.4%, P 〈 0.01）. After chemotherapy, the lymphocyte counts of pediatric patients with solid tumors significandy decreased, especially the counts of CD19 ＋ ceils and CD4 ＋ cells （P〈0.01）. The ratio of CD4/CD8 decreased significandy （P〈0.01）. Conclusion Compared with health children, the incidence of lymphopenia among pediatric patients with solid tumors is high. The lymphocyte count decreases significantly after one course of chemotherapy, especially B lymphocytes and CD4 ＋ T lymphocytes. The humoral immune is impaired early.More attention should be paid to lymphocyte proliferation and humoral immune supplement, which may be helpful for preventing infections after chemotherapy.