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、IgA、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（CD4＋／CD8＋）。结果（1）体液免疫方面：＜1岁者 IgA 水平较正常明显下降（＜0．0667 g／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 CD4＋／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。

abstractsObjective 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 201 1 to June 201 4 were selected.RB International In-traocular 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 -lymphocytes,helper T -lymphocytes (THL)and suppressor T -lymphocytes(TSL),natural killer cells 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 identical clinical stage:for children >3 years old,the CD4 +/CD8 + ratios in the patients with bilateral RB were significantly lower than those in the patients with unilateral RB (P =0.027).Conclusion The genesis and development of RB may be related to the changes in immunity conditions,especially the cellular immunity indexes.To monitor the subpopulations of T cells can provide the guidance for prognosis prediction and the application of relevant immune regulation drugs.