鼻咽癌综合治疗后复发或放射性颅底骨坏死患者治疗前后EB病毒DNA、病毒衣壳蛋白抗原-IgA和早期抗原-IgA的表达及意义

Expression of epstein-barr virus DNA,viral capsid antigen-lgA and early antigen-IgA in patients with recurrence or radiation necrosis of skull base after comprehensive treatment of nasopharyngeal carcinoma and its clinical significance

目的探讨鼻咽癌综合治疗后复发患者治疗前后EB病毒-DNA(EBV-DNA)、病毒衣壳蛋白抗原-lgA(VCA-IgA)和早期抗原-IgA(EA-IgA)的表达及意义。方法将150例鼻咽癌复发患者纳入复发组,按照是否应用鼻内镜手术分为手术组93例和放化疗组57例。选取36例放射性颅底骨坏死患者为对照组(无复发)。比较各组患者治疗前后血VCA-IgA、EA-IgA、EBV-DNA阳性率。结果治疗前,复发组的血浆EBV-DNA阳性率显著高于对照组(P<0.01);2组的VCA-IgA和EA-IgA阳性率组间比较均无显著差异(P>0.05)。治疗前,不同复发类型患者其血浆EBV-DNA、VCA-IgA和EA-IgA阳性率组间比较均无显著差异(P>0.05)。临床分期越高,治疗前EBV-DNA阳性率越高(P<0.01);不同临床分期患者治疗前其血浆VCA-IgA及EA-IgA阳性率组间比较无显著差异(P>0.05)。治疗前,放化疗组与手术组的血浆EBV-DNA、VCA-IgA、EA-IgA阳性率组间比较均无显著差异(P>0.05)。治疗结束时,手术组的血浆EBV-DNA转阴率为91.30%,显著高于放化疗组的68.75%(P<0.05)。放化疗组患者的血浆EBV-DNA阳性率显著高于手术组(P<0.01),但2组VCA-IgA及EA-IgA阳性率组间比较均无显著差异(P>0.05)。结论鼻内镜手术治疗可明显降低鼻咽癌患者的EBV水平,检测EBV-DNA水平对于判断鼻咽癌是否复发及临床分期具有重要意义。

Objective To investigate the expression of epstein-barr virus DNA , viral capsid antigen-lgA and early antigen-IgA in patients with recurrence or radiation necroscomprehensive treatment of nasopharyngeal carcinoma and its clinical significance. Methods A total of 150 patients with recurrent nasopharyngeal carcinoma （ NPC ） treated in our hospital were dividedinto operation group （ n = 93 ） and chemoradiotherapy group （ n = 57）. At the same with skull base necrosis were selected as control group （without recurrence） . The positive rates ofVCA-IgA , EA-IgA and EBV-DNA in each group before and after treatment were compared. Results Before treatment , the positive rate of plasma EBV-DNA of recurrence group was than that of the control group（P 〈0. 01） . The positive rate of VCA-IgA and EA-IgA between two groups showed no statistically significant difference （ P 〉0.05）. Before treatment , there was no statistical significant difference in the positive rate of plasma EBV- DNA, VCA-IgA and EA- Igj／ among different groups （P 〉0.05）. The higher clinical stage was, and the higher positive rate of EBfore treatment （P 〈0. 01）. There was no significant difference in the positIgA and EA-IgA among the patients with different clinical stages （P 〉0.05）. After treatment, thenegative rate of EBV-DNA was 91.3 0 % in the operation group, which was signi68.75% in the chemoradiotherapy group. The positive rate of plasma EBV-DNA group was significantly higher than that in the surgery group （ P 〈 0. 01 ） , but the VCA-IgA and EA-IgA between groups showed no significant difference （P 〉0.05）. Conclusion Endoscopic sinus surgery can significantly reduce the level of EBV in NPC patietion of EBV-DNA is of great significance in the diagnosis of recurrence and clinical staging of NPC.