摘要或動機

罹患神經母細胞瘤的兒科病人，尤其是罹患stage IVs 神經母細胞瘤者，他們有些伴隨著非常嚴重的貧血，但卻檢測不出神經母細胞瘤已經侵犯骨髓；有時病情來勢洶洶，尤其是腫瘤細胞中已可偵測到N-myc 基因增幅者，診斷時腫瘤細胞可能已在腹腔四處擴散並已侵犯大部分的肝臟。但是，某些這種病患，特別是腫瘤細胞中N-myc 基因沒增幅者，即使在沒有治療的狀況下卻可能有自然恢復的現象，也就是腫瘤細胞會自動消退，但原因仍待進一步的證實與探討。可是，這些病人在其病情最嚴重的時候，骨髓內紅血球母細胞形態上的改變顯示可能與病毒感染有關。但是關於病毒來源的研究，現有的資訊仍然十分有限，其中最重要的是，病毒感染與引發其後天之免疫作用是否有關，更需要深層的研究。因此，為更進一步了解罹患神經母細胞瘤之兒科病人的病毒感染及病毒蛋白表現的作用，我們這次研究的目的在檢驗罹患神經母細胞瘤及貧血之兒科病人與微小病毒B19 (PVB19)、Epstein-Barr Virus (EBV)、腸病毒71 型(EV 71)和巨細胞病毒(CMV)的關係，以及病毒蛋白表現對這些病人的作用與臨床意義。In pediatric patients with neuroblastoma, in particular, those with stage IVs neuroblastoma, sometimes the disease was combined with severe anemia. However, no tumor involvement was detected in the bone marrow. Although some of these patients may have N-myc gene amplification, and the disease could have invaded many abdominal organs, especially liver, interestingly, the disease might regress spontaneously in some of these patients. The medical reason of the spontaneous regression, nonetheless, remains to be determined. It is worth noting that morphological changes of erythroid progenitor cells in the bone marrow have suggested virus infection in these pediatric patients. However, the available information of viral origin is limited. Furthermore, it is possible that the virus infection in these patients could be associated with the revocation of immune responses related to the spontaneous regression of the tumor. In this study we will investigate the relationship of parvovirus B19 (PVB19), Epstein-Barr virus (EBV), enterovirus 71 (EV71) and cytomegalovirus (CMV) with neuroblastoma by PCR in Taiwanese pediatric patients. Moreover, we will study the effect and the clinical significance of viral gene expression as well as N-myc gene amplification in these patients.