EB病毒抗体联合检测在鼻咽癌血清学诊断中的价值  

Combined detection of Epstein-Barr virus antibodies for serodiagnosis of nasopharyngeal carcinoma

作　　者：蔡永林[1] 郑裕明[1] 王伟[2] 魏轶[3] 申雪翔[4] 成积儒 吴英松[5] 高健全[1] 钟伟铭 李军[1] 

机构地区：[1]梧州市红十字会医院,广西梧州543002 [2]南方医科大学南方医院,临床医学实验研究中心,广东广州510515 [3]南方医科大学南方医院康复医学科,广东广州510515 [4]长沙市妇幼保健院,湖南长沙410007 [5]南方医科大学南方医院生物技术学院,广东广州510515

出　　处：《南方医科大学学报》2010年第12期2746-2748,共3页Journal of Southern Medical University

摘　　要：目的评价VCA/IgA、EA/IgA、Rta/IgG和EBNA1/IgA等EB病毒抗体联合检测在鼻咽癌血清学诊断中的价值。方法收集211例初治鼻咽癌和203例相似症状的非鼻咽癌病例的血清,采用免疫酶法检测VCA/IgA及EA/IgA,酶联免疫吸附法检测Rta/IgG和EBNA1/IgA。应用ROC曲线分析确定各抗体检测的最佳截断值,采用复合阳性判断方法评价联合检测对鼻咽癌的诊断价值。结果采用复合阳性判断方法,联合检测的敏感度及特异度比单项抗体的指标基本上均有提高。VCA/IgA+Rta/IgG+EBNA1/IgA组合的敏感度(98.1%)较其它3种组合高,特异度、准确度、约登指数及阳性预测值分别为88.7%、93.5%、0.868、90.0%;而EA/IgA+Rta/IgG+EBNA1/IgA组合的特异度(95.1%)、准确度(94.9%)、约登指数(0.899)及阳性预测值(95.2%)最高,敏感度为94.8%,显示其在鼻咽癌血清学诊断中可能具有更高的准确性。四抗体组合有最高的敏感度(98.6%),特异度、准确度、约登指数及阳性预测值分别为88.2%、93.5%、0.868、89.7%。结论抗立即早期抗原Rta/IgG抗体、抗早期抗原EA/IgA抗体、抗晚期抗原VCA/IgA和抗潜伏期抗原EBNA1/IgA抗体联合检测可更大范围地反映EB病毒溶解感染期及潜伏感染期的抗原表达,具有很好的互补作用,是鼻咽癌血清学诊断的合适组合。Objective To investigate the value of combined detection of Epstein-Barr virus （EBV） VCA/IgA,EA/IgA,Rta/IgG and EBNA1/IgA in serodiagnosis of nasopharyngeal carcinoma （NPC）. Methods Serum samples obtained from 211 untreated patients with NPC and 203 non-NPC ENT patients were examined for the presence of VCA/IgA and EA/IgA by immunoenzymatic assay and for Rta/IgG and EBNA1/IgA by enzyme-linked immnunosorbent assay （ELISA）. The receiver operating characteristic （ROC） curve was generated to confirm the cutoff values of different antibodies. The evaluation indexes of combined detection of multiple antibodies used for serodiagnosis of NPC were calculated with compounded positive judgment method. Results Compared to a single antibody,combined detection achieved a higher sensitivity and specificity. The sensitivity of VCA/IgA ＋ Rta/IgG ＋ EBNA1/IgA （98.1%） was higher than the other 3 combinations with a specificity,accuracy,Youden index and positive predictive value （PPV） of 88.7%,93.5%,0.868 and 90.0%,respectively. The combination of EA/IgA＋Rta/IgG＋EBNA1/IgA had the highest specificity （95.1%）,accuracy （94.9%）,Youden index （0.899） and PPV （95.2%）,with a sensitivity of 94.8%,suggesting its higher accuracy in the serodiagnosis of NPC. Combined detection of the 4 antibodies had the highest sensitivity （98.6%） with a specificity,accuracy,Youden index and PPV of 88.2%,93.5%,0.868 and 89.7%,respectively. Conclusion Combined detection of Rta/IgG against immediate early antigens,EA/IgA against early antigens,VCA/IgA against late antigens,and EBNA1/IgA against latent antigens provides better understanding of the expression profiles of EBV lytic and latent antigens with excellent complementarity,and may serve as an optimal combination for NPC serodiagnosis.

关 键 词：鼻咽癌 EB病毒 抗体 血清学诊断 

分 类 号：R739.63[医药卫生—肿瘤]