488683人鼻咽癌普查基本方案分析

The basic screening project in 488683 persons for nasopharyneal carcinom a

目的 分析488 683人鼻咽癌普查结果,其中20 726人是广西梧州市鼻咽癌高发现场1980 年普查及10 年追踪观察和对查出EB病毒IgA/VCA抗体阳性者20年追踪观察结果,467 957人是现场以外其它地区普查结果,两者结果比较分析提出鼻咽癌普查和社区应用基本方案。方法 应用免疫酶法检测EB病毒IgA/VCA抗体,间接鼻咽镜配合,在现场和现场以外其它地区进行鼻咽癌普查。结果 现场20 726人普查及10年和20 年追踪观察,IgA/VCA抗体阴性19 590 人10 年内发生鼻咽癌4例,其中3例确诊时IgA/VCA抗体已显阳性反应,仅1 例仍为阴性,IgA/VCA抗体阳性1 136 人普查及20 年追踪观察检出鼻咽癌60例,其中接受随访的54例中,有46例属早期,早诊率85.2%,IgA/VCA抗体诊断鼻咽癌符合率98.3%。现场以外其它地区普查467 957人,检出鼻咽癌188例,其中属于早期患者为164 例,早诊率87.2%,可以重复现场结果。结论 免疫酶法检测EB病毒IgA/VCA抗体普查鼻咽癌,间接鼻咽镜配合,方法简单、价廉、诊断符合率高,可以检出鼻咽癌早期病人,是鼻咽癌普查或社区服务的首选基本方案,其它抗体检测可在这基础上互补,符合成本效益卫生经济学观点。

Objective This study aimed to establish a basic p roject for nasopharyneal carcinoma (NPC) screening and community application by analyzing the screening results in 488683 persons.Of all,20726 persons comes from Wuzhou hig incidence area of NPC by serological screening in 1980,the sero negative subjects were followed up for 10 years,and seropositive for 20 years;46 7 957 came from other areas of non-high incidence of NPC.Methods By using the indirect immuo-enzymatic detection for EBV IgA/VCA antibody com bined with the indirect nasopharyngoscope examination,the NPCC screening was per formed in high incidence area and other areas of non-high incidence.Res ults In high incidence area of NPC where 20 762 persons werescreend and followed up for 10 to 20 years,4 cases of NPC were founded in 19 590 persons of negative for IgA/VCA antibody during 10 year follow-up,and the antibody reacti ons of 3 cases were turned to positive when they were diagnosed to NPC,only one still was negative;60 cases of NPC were founded in 1 136 persons of positive for IgA/VCA antibody during 20 year follow-up,early-diagnose rate was 85.2% and t he according rate oof NPC diagnose by detecting IgA/VCA antibody was 98.3%.In ot her areas of non-high incidenes of NPC where 467 957 persons were screened,188 cases of NPC were found,the early-dyagnose rate was 87.2%,and the screening res ults were similar to that of the high incidence area of NPC.Conclusion This project of the immuo-enzymatic detection for EBV IgA/VCA antibody combined with the indirect nasopharyngoscope examination has the advantages of s imple, convenient,economy and high according rate,and it can help NPC cases to b e detected at early stage.The project is recommended to be a first-line plan in NPC screening and community application.Additionally,it is better to improve cl inic diagnosis effect involving the combination of this project and other antibo dy detections.