鼻咽癌高癌家族的监控和筛查  

Surveillance of high risk families for nasopharyngeal carcinoma

作　　者：张锋[1] 莫浩元[1] 黄晓明[1] 邓满泉[1] 张爱兰[1] 李经略[2] 叶永熙 冯凯涛[2] 孙韵[2] 曾益新[3] 

机构地区：[1]中山医科大学肿瘤防治中心鼻咽癌科,广东广州510060 [2]中山医科大学肿瘤防治中心中心实验室,广东广州510060 [3]中山医科大学肿瘤防治中心肿瘤研究所,广东广州510060

出　　处：《癌症》2000年第11期984-986,共3页Chinese Journal of Cancer

基　　金：国家973重大项目!(No: G1998051201)"鼻咽癌易感基因的定位与克隆"的分题资助

摘　　要：目的：通过对高癌家族成员的有效监控，探索筛查无明显症状的早期鼻咽癌病人的方法，以提高鼻咽癌早期发现、早期诊断和早期治疗。方法：选择在两代人中有 3个以上鼻咽癌患者的“高癌家系”作为本组“监控家系”，对其有血缘关系的亲属（ 1～ 3级亲属）共 121人作为本组的监控对象，对他们进行详细的鼻咽及头颈部临床检查、 EB病毒血清学抗体检测、血标本作基因定位检测。定期（约 6个月）进行追踪复查，对有可疑患癌者即作鼻咽光导纤维镜检查及鼻咽活检组织病理学检查。一旦确诊鼻咽癌，即安排治疗。结果：在接受监控的 15个家系的 121个家庭成员中，检测 EB病毒血清抗体 IgA/VCA（≥ 1∶ 10）阳性者 42人，酶联免疫吸附（ ELISA法）检测 IgG/EA（≥ 0.18）者 31人 ,阳性率分别为 34.9％及 25.6％。经首次检查及以后的 6～ 19个月追踪观察中共发现新鼻咽癌 6例，癌检出率为 4.13％（ 6/121）。 6例鼻咽癌中，Ⅰ期 5例、Ⅱ期 1例。结论：⑴鼻咽癌高癌家族成员 EB病毒相关抗体呈高阳性表达， EB病毒血清抗体检测是最佳的筛查手段；⑵鼻咽癌高癌家族人员是鼻咽癌发生的高危人群，对他们进行监控、定期追踪复查，可提高三早率，提高鼻咽癌治疗效果。Objective： The current study was designed to increase the rate of early diagnosis of nasopharyngeal carcinoma(NPC) through surveillance of families with three or more patients in two generations. Methods： A total of 121 family members from 15 families were investigated and regarded as“ surveillance objectives” . Detailed checking on site of nasopharynx, head and neck and detection of serum Epstein- Barr virus (EBV) antibodies were performed every three to six months. Suspected cases were further checked with optical fiberscope and pathological detection. Results： Positive results of IgA/VCA(≥ 1∶ 10) were detected in 42 persons of 121 family members(34.9％ ) and positive results of IgG/EA(A≥ 0.18) were in 31 of 121 family members(25.6％ ) . From first check through following 6－ 19 months observation, 6 NPC cases were newly diagnosed with the positive rate of 4.13％ (6/121), in which, five cases were in stage I, and one in stage II. Conclusion： (1) High level expressions of EBV antibodies in family members of high risk pedigrees of NPC were observed, which can be utilized as a screening method. (2) Family members in these pedigrees are risk population to NPC. Surveillance and screening should be conducted in order to enhance early diagnosis.

关 键 词：鼻咽肿瘤 高癌家族 EB病毒 监控 筛查 

分 类 号：R739.63[医药卫生—肿瘤]