鼻咽癌复发患者EB病毒DNA及抗体的表达情况及其临床意义

Expression of Epstein-Barr virus DNA and antibody in patients with recurrent nasopharyngeal carcinoma and its clinical significance

目的探讨鼻咽癌复发患者治疗前后EB病毒(EBV)-DNA、病毒衣壳蛋白抗原-IgA(VCA-IgA)和早期抗原-IgA(EA-IgA)的表达情况及其临床意义。方法选择鼻咽癌复发患者124例为复发组,其中手术组77例,采用鼻内镜手术或鼻内镜手术联合放、化疗;放化疗组47例,采用放疗和(或)化疗。另选取30例鼻咽癌治疗后放射性颅底骨坏死患者(无复发)为对照组。在治疗前及治疗结束时,检测所有患者血清VCA-IgA、EA-IgA、EBV-DNA阳性表达情况。结果治疗前,复发组、对照组EBV-DNA阳性率分别为51.61%、0,两组VCA-IgA和EA-IgA阳性率比较,差异均无统计学意义(P>0.05)。治疗前,局部、颈部、局部及颈部复发的鼻咽癌患者间EBV-DNA、VCA-IgA和EA-IgA阳性率比较,差异无统计学意义(P>0.05)。在Ⅰ期、Ⅱ期、Ⅲ期及Ⅳ期复发鼻咽癌患者中,EBV-DNA阳性率随临床分期增高而增高(P<0.05),但VCA-IgA及EA-IgA阳性率比较差异无统计学意义(P>0.05)。治疗前,手术组与放化疗组EBV-DNA、VCA-IgA、EA-IgA阳性率比较,差异均无统计学意义(P>0.05);治疗后,手术组EBV-DNA转阴率高于放化疗组(P<0.05),且手术组EBV-DNA阳性率低于放化疗组(P<0.05),但两组VCA-IgA及EA-IgA阳性率比较,差异无统计学意义(P>0.05)。结论检测EBV-DNA可能有助于判断鼻咽癌复发和分期,手术治疗有助于清除机体的EBV。但在鼻咽癌治疗后放射性颅底骨坏死患者中仍可检出VCA-IgA、EA-IgA,建议对患者的抗体水平进行动态观察。

Objective To explore the expressions of Epstein-Barr virus（ EBV）-DNA,viral capsid antigen-IgA（ VCA-IgA） and early antigen-IgA（ EA-IgA） in patients with recurrent nasopharyngeal carcinoma（ NPC） before and after treatment,and its clinical significance.Methods A total of 124 patients with recurrent NPC were enrolled as recurrent group,including 77 cases treated with nasal endoscopic surgery or nasal endoscopic surgery combined with chemoradiotherapy（ surgery group） and 47 cases treated with radiotherapy or chemotherapy（ radiochemotherapy group）. And 30 non-recurrent NPC patients with skull base osteoradionecrosis（ ORN） after radiotherapy were enrolled as control group. Before and after treatment,the positive expressions of serum VCA-IgA,EA-IgA and EBV-DNA were detected. Results Before treatment,the positive rates of EBV-DNA in the recurrent group and control group were 51. 61% and 0 respectively,and there were no statistical differences in the positive rates of VCA-IgA and EA-IgA between the two groups（ P〉0. 05）. No significant differences in the positive rates of EBV-DNA,VCA-IgA and EA-IgA were observed among the NPC patients with local recurrence,neck recurrence and local and neck recurrence before treatment（ P〉0. 05）. Among the recurrent NPC patients with stage Ⅰ,stage Ⅱ,stage Ⅲ and stage Ⅳ,the positive rate of EBV-DNA increased with the increase of clinical staging（ P〈0. 05）,but no statistical differences in the positive rates of VCA-IgA and EA-IgA were observed（ P〈0. 05）. Before treatment,there were no statistical differences in the positive rates of EBV-DNA,VCA-IgA and EA-IgA between thesurgery group and the chemoradiotherapy group（ P〉0. 05）. After treatment,the seroconversion rate of EBV-DNA was higher and the positive rate of EBV-DNA was lower in the surgery group compared to the chemoradiotherapy group（ P〈0. 05）,but there were no statistical differences in the positive rates of VCA-IgA and EA-IgA between the two groups（ P〉0. 05）. Conclusion The detection of EBV-DNA may be helpful for assessing the recurrence and staging of NPC,and surgical treatment may be helpful for the removal of EBV. But VCA-IgA and EA-IgA remain detectable in NPC patients with ORN after radiotherapy,therefore,it is suggested that dynamic observation on the levels of antibodies should be performed among patients.