动态监测EB病毒抗体对鼻咽癌的诊治价值

Value of dynamic monitoring Epstein-Barr virus antibodies to the diagnosis and treatment of nasopharyngeal cancer

目的探讨鼻咽分泌物EB病毒抗体联合检测在鼻咽癌早期诊断及治疗中的应用价值。方法鼻咽癌患者45例均行根治性放疗,分别于治疗前及治疗后1、4、8周采集患者鼻咽分泌物,检测EB病毒VCA-IgA、EA-IgG、NA1-IgA、Rta-IgG表达水平,观察放疗期间患者EB病毒抗体水平变化,分析4项抗体单独及联合检测在鼻咽癌诊断中的价值。结果 4项EB病毒抗体单项检测,VCA-IgA诊断鼻咽癌的灵敏度最高(94.7%),EA-IgG诊断鼻咽癌的特异度最高(91.4%),VCA-IgA、EA-IgG诊断鼻咽癌的准确度一致(均为87.1%);4项抗体联合检测诊断鼻咽癌的灵敏度(97.4%)、准确度(88.2%)高于单一抗体检测,但特异度降低(81.3%);与治疗前比较,鼻咽癌患者VCA-IgA、EA-IgG、Rta-IgG表达水平随治疗时间延长逐渐降低(P<0.05),NA1-IgA表达水平与治疗前比较差异无统计学意义(P>0.05)。结论 4项EB病毒抗体联合检测可提高鼻咽癌早期诊断的准确度、灵敏度,动态监测EB病毒抗体水平变化可为鼻咽癌治疗提供依据。

Objective To evaluate the significance of combined detection of Epstein-Barr （EB） virus antibodies in the early diagnosis and treatment of nasopharyngeal cancer. Methods Forty-five patients with nasopharyngeal cancer received radical radiotherapy. The expression levels of EB viruses in nasopharyngeal secretion including VCA-IgA, EA-IgG, NA1- IgA and Rta-IgG were detected before treatment, and 1, 4 and 8 weeks after treatment. The expression of EB virus antibodies were dynamically observed to analyze the value of single or combined detection of antibodies to the diagnosis of nasopharyngeal cancer. Results The sensitivity of VCA-IgA was the highest （94.7%）, and the specificity of EA-IgG was the highest （91.4%） for nasopharyngeal cancer. The accuracies of both VCA-IgA and EA-IgG were 87.1%. The sensitivity and accuracy of combined detection of four antibodies were 97.4% and 88.2%, higher than single detection, but the specificity was lower （81.3%）. Compared with before treatment, the expressions of VCA-IgA, EA-IgG and Rta- IgG decreased along with the prolong of treatment time （P〈0. 05）, and there was no significant difference in NAI-IgA expression （P〉0.05）. Conclusions The combined detection of four EB virus antibodies can improve the accuracy and sensitivity of early diagnosis of nasopharyngeal cancer, and the dynamic detection of EB virus antibodies provides guidance for clinical treatment of nasopharyngeal cancer.