血浆EB病毒DNA含量定量检测对鼻咽癌的诊断和预后评价

Plasma level determination of EB virus DNA for diagnosis making and prognosis estimating among cases with nasopharyngeal carcinoma

目的探讨血浆EB病毒DNA定量检测对鼻咽癌的诊断和预后评估价值.方法收集2002年2月～2003年6月在本院确诊的初诊鼻咽癌患者100例,放疗后鼻咽癌患者106例,以及健康对照者40例,分别采集血浆标本,应用Real-time PCR方法检测EB病毒DNA含量,比较健康者和初诊鼻咽癌患者、放疗后转移或复发及持续临床缓解鼻咽癌患者的血浆EB病毒DNA拷贝数差异.结果初诊鼻咽癌患者、放疗后转移和复发鼻咽癌患者的血浆中游离EB病毒DNA检出阳性率分别为90.7%（97/100）,96.5%（27/28）和100.0%（18/18）,明显高于健康对照组的7.5%（3/40）,持续临床缓解鼻咽癌患者的10.0%（6/60）和其他肿瘤患者的阳性检出率（P＜0.001）.血浆EB病毒DNA定量检测对初诊鼻咽癌患者的诊断敏感性为97.0%,特异性为92.0%.另有3例持续临床缓解而血浆EB病毒DNA水平升高的鼻咽癌患者,在随后的6个月随访中,最终出现肿瘤复发或转移.结论血浆EB病毒DNA定量检测是一种敏感而可靠的实验方法,对鼻咽癌的诊断、病情监测和预后评估具有重要价值.

Objective To investigate the value of plasma level determination of EB virus （EBV） DNA for diagnosis making and prognosis estimating among cases with nasopharyngeal carcinoma （NPC）. Methods Included in this study were 100 cases with untreated NPC, 106 NPC cases following radiotherapy, finally diagnosed in our Hospital from Mar, 2002 to Jun, 2003, and 40 healthy persons as control. Their plasma samples were collected respectively and the plasma levels of EBV DNA were determined by real-time PCR techniques among them. Then, a comparative analysis was made to see the differences of EBV DNA copies and their clinical implications among healthy controls, unreated NPC cases, NPC cases with distal metastasis after radiation, ones with locally reoccurring NPC following radiotherapy, and ones still with nasopharyngeal lesion remission after treatment. Results The positive rates of plasma EBV DNA determination were 97.0 % （97/100）, 96.5 % （27/28）and 100.0 % （18/18） for untreated NPC cases, NPC cases with distal metastasis after radiation, and ones with locally reoccurring NPC following radiotherapy, with significantly higher rates than the positive rate of 7.5% （3/40）among healthy controls, that of 10.0% （6/60）among cases still with nasopharyngeal lesion remission after treatment, and that of the cases with other kinds of tumors（P 〈 0. 001）. As a diagnos-tic test, plasma EBV DNA determination held a sensitivity of 97.0 % and a specificity of 92.0 % for the diagnosis of untreated NPC cases. Furthermore, another 3 cases were confirmed at last with the nasopharyngeal focus reoccurred or being distal metastatic during the following up period lasted for 6 months, while they were all seen still with nasopharyngeal lesion remission after treatment but with elevated plasma level of EBV DNA at the time point of trial starting. Conclusion Plasma level determinattion of EBV DNA is a sensitive and reliable test for diagnosing of untreated NPC eases, monitoring of such a case following therapy, and estimating of prognosis of cases with NPC.