EB病毒相关胃癌病人血清EB病毒抗体检测及意义

DETECTION OF SERUM ANTIBODIES TO EPSTEIN-BARR VIRUS IN PATIENTS WITH EPSTEIN-BARR VIRUS-ASSOCIATED GASTRIC CARCINOMA AND ITS CLINICAL SIGNIFICANCE

目的检测EB病毒相关胃癌(EBVaGC)病人血清中EB病毒相关抗体,对EBVaGC进行快速的鉴别诊断。方法应用原位杂交技术确认EBVaGC病人20例,以临床病理资料与之相匹配的EB病毒阴性胃癌(EBVnGC)病人60例作对照,应用化学发光法检测EB病毒相关抗体水平,采用阳性率、灵敏度、特异度、阳性似然比、阳性预测值等参数来评估这些抗体诊断EBVaGC的效率。结果EBVaGC组与EBVnGC组病人血清EBV EA IgG、EBV VCA IgA阳性率比较,差异具有统计学意义(χ^2=23.89、3.88,P<0.05);两组血清EBV EA IgA、EBV VCA IgM、EBV VCA IgG、EBV NA IgG阳性率比较差异无显著性(χ^2=1.89~2.88,P>0.05)。EBV EA IgG、EBV VCA IgA阳性似然比、阳性预测值均高于其他4项抗体(χ^2=5.19~20.18,P<0.05)。EBV VCA IgG、EBV NA IgG灵敏度虽高,但是特异度极低;EBV EA IgA特异度虽高,但是灵敏度偏低;EBV EA IgG、EBV VCA IgA较其他相关抗体兼具较高的灵敏度和特异度(χ^2=11.65~29.62,P<0.05)。结论对EB病毒抗体进行血清学检测,有利于EBVaGC的有效筛查,且不同抗体检测的灵敏度、特异度有一定差异;联合检测可以弥补单项抗体指标无法兼顾灵敏度、特异度的缺点,为EBVaGC的快速鉴别诊断提供可靠依据,具有较高的临床应用价值。

Objective To make a rapid differential diagnosis of Epstein-Barr(EB)virus-associated gastric carcinoma(EBVaGC)by detecting the serum antibodies to EB virus in patients with EBVaGC.Methods A total of 20 patients with EBVaGC confirmed by in situ hybridization were enrolled as EBVaGC group,and 60 patients with EB virus-negative gastric carcinoma(EBVnGC),matched for clinicopathological data,were enrolled as EBVnGC group.Chemiluminescence was used to measure the levels of antibodies to EB virus,and the parameters including positive rate,sensitivity,specificity,positive likelihood ratio,and positive predictive value were used to evaluate the efficiency of these antibodies in the diagnosis of EBVaGC.Results There were significant differences between the EBVaGC group and the EBVnGC group in the positive rates of EBV EA IgG and EBV VCA IgA(χ^2=23.89,3.88;P<0.05),and there were no significant differences in the positive rates of EBV EA IgA,EBV VCA IgM,EBV VCA IgG,and EBV NA IgG between the two groups(χ^2=1.89-2.88,P>0.05).EBV EA IgG and EBV VCA IgA had significantly higher positive likelihood ratio and positive predictive value than the other four antibodies(χ^2=5.19-20.18,P<0.05).EBV VCA IgG and EBV NA IgG had high sensitivity and extremely low specificity,while EBV EA IgA had high specificity and re-latively low sensitivity,and EBV EA IgG and EBV VCA IgA had higher sensitivity and specificity than the other antibodies(χ^2=11.65-29.62,P<0.05).Conclusion Serological detection of antibodies to EB virus is beneficial to the effective screening for EBVaGC and different antibodies have different sensitivities and specificities.Combined measurement can overcome the shortco-ming that a single antibody is unable to perform well in both sensitivity and specificity and provide reliable evidence for the rapid differential diagnosis of EBVaGC,and therefore,it has a high clinical value.