血浆EBV-DNA水平测定在监测鼻咽癌高危人群中的临床应用意义

The clinical significance of EBV DNA analysis in nasopharyngeal carcinoma screening

目的:探讨血浆EBV-DNA水平测定在监测鼻咽癌高危人群中的临床应用意义。方法:采用ELISA法对15 864例筛查者进行鼻咽癌相关EBV抗体检测,共筛检出鼻咽癌高危人群366例,同时在低危人群中随机选取262例进行研究。另外选取同期因鼻咽癌进行治疗的早期鼻咽癌患者58例。对366例鼻咽癌高危人群采用PCR法进行EBV-DNA检测,并对其进行为期1年的跟踪观察,比较分析EBV-DNA在鼻咽癌筛查中的临床应用意义。结果:初筛显示为高危人群的EBV-DNA检测阳性率为12.0%,初筛显示为低危人群的EBVDNA检测阳性率为3.4%,临床初诊为鼻咽癌的患者EBV-DNA检测阳性率为91.4%,3组阳性率比较差异有统计学意义(P<0.01);在为期1年的跟踪随访后共267例参加复诊,其中血清学指标呈持续高危的患者阳性率高于初筛时显示高危而复诊后显示为非高危的患者,其差异有统计学意义(P<0.05)。结论:鼻咽癌筛查在常规采用血清EBV评估的基础上联合EBV-DNA检测可明显提高筛查的准确率,有效提高临床上的筛查范围,对于病理诊断具有一定的临床意义,可在一定范围内推广应用。

Objective：The aim of this study is to explore the value of EBV DNA monitor in high risk population of nasopharyngeal carcinoma（NPC）.Method：A total of 366 cases of NPC at high risk were screened for 15864 cases by ELISA,and 262 cases were randomly selected from low-risk groups.Fifty-eight nasopharyngeal carcinoma patients were also involved.EBV DNA was detected by PCR in 366 NPC high risk patients and followed up for 1 year.The clinical significance of EBV-DNA in screening NPC was compared.Result：The positive rate of EBV-DNA test was 12.0%in primary screening,EBV-DNA test in primary screening was 3.4%in low-risk population,and EBV-DNA in nasopharyngeal carcinoma was 91.4%,The positive rate of the three groups was statistically significant（P〈0.01）;After one year follow-up,a total of 267 cases returned visit.Positive rate of group A with continuous high risk was significantly higher than group B who was high risk at the first time of visit and non high risk at returned visit（P〈0.05）.Conclusion：Quantitative analysis of plasma EBV DNA in high risk population can supply serological risk assessment.It can elevate the efficiency of screening and has significant application value for NPC high risk population.