鼻咽癌筛查中三种EB病毒抗体检测的应用  

The value of detection of three anti-Epstein-Barr viral antibodies for nasopharyngeal carcinoma diagnosis

作　　者：张晓琍[1] 周建林[2] 曹颖平[1] 

机构地区：[1]福建医科大学附属协和医院检验科,福州350001 [2]福建医科大学附属第三医院检验科

出　　处：《中华检验医学杂志》2015年第2期111-114,共4页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金（81171656）

摘　　要：目的探讨EB病毒Rta蛋白IgG抗体（Rta—IgG）、EB病毒衣壳抗原IgA抗体（VCA-IgA）和EB病毒早期抗原IgA抗体（EA-IgA）在鼻咽癌筛查中的意义。方法用调查法收集2012年5月至2013年7月在福建医科大学附属协和医院体检的健康人群体检组8884名，因鼻咽部临床相关症状就诊我院耳鼻喉科的临床筛查组1546例，经我院病理确诊为鼻咽癌的鼻咽癌组155例，3组血清标本的EB病毒Rta．IgG、VCA—IgA和EA．IgA用ELISA法检测的结果，并分析评价各指标在诊断鼻咽癌中的价值。3种抗体检出阳性率的比较用卡方检验。结果在鼻咽癌组，EB病毒Rta—IgG、VCA．IgA和EA—IgA阳性检出率分另0为81．9％（127／155）、90．3％（140／155）、48．3％（75／155），与临床筛查组及体检组相比明显升高，且差异均有统计学意义（石。分别为1538．6、479．3、643．3，P均〈0．01）。VCA．I外敏感度最高90．3％（140／155），EA—IgA特异度最好95．1（9915／10430）；进一步分析显示，Rta-IgG、VCA—IgA和EA．IgA对鼻咽癌的诊断均有很好的阴性预测值，阴性预测值分别为99．7％（9826／9854）、99．8％（8168／8183）、99．2％（9915／9995）；联合检测Rta—IgG、VCA-IgA和EA-IgA有利于提高鼻咽癌诊断的敏感度94．1％（146／155）和特异度98．9％（10469／10585）。结论鼻咽癌患者血清Rta-IgG、VCA—IgA、EA—IgA抗体均具有一定的临床诊断价值，联合检测这3项指标有助于提高鼻咽癌的诊断效率及准确性。Objective To evaluate the value of Epstein-Barr virus （EBV） IgG antibody to EBV Rta protein（Rta-IgG）, IgA antibody to EBV early antigen （EA-IgA） and IgA antibody to EBV viral capsid antigen（VCA-IgA） for nasopharyngeal carcinoma （NPC） diagnosis. Methods From May 2012 to July 2013, serum samples from 8 884 healthy donors, 1 546 clinical screening patients and 155 NPC patients in Fujian Medical University Union Hospital were collected, and EBV Rta-IgG, EA-IgA and VCA-IgA were detected by ELISA. The ROC curve analysis and correlation analysis were performed to assess the value of Rta-IgG, EA-IgA and VCA-IgA for NPC diagnosis. The positive rate among three kinds of antibodies were compared with chi-square test. Results Positive rates of EBV Rta-IgG, VCA-IgA and EA-IgA in NPC patient group were 81.9% （127/155） ,90. 3% （140/155） and 48.3% （75/155）, respectively, which were higher than those in clinical screening patient group and healthy donor group （X2 = 1 538.6, 479. 3 and 643.3 respectively,P 〈 0. 01 ）. The sensitivity of VCA-IgA （90. 3%, 140/155） and the specificity of EA- IgA （95.1%, 9 915/10 430 ） were the highest in all groups. Further analysis showed that negative predictive value of EBV Rta-IgG, VCA-IgA and EA-IgA for NPC diagnosis were 99. 7% （9 826/9 854）, 99. 8% （8 168/8 183）, 99. 2% （9 915/9 995）, respectively, suggesting that three anti-EBV antibodies showed very good negative predictive value for NPC diagnosis. Next, combined detection of three anti-EBV antibodies could improve the sensitivity （94. 1%, 146/155 ） and specificity （98. 9%, 10 469/10 585 ） for the NPC diagnosis. Conclusion The EBV Rta-IgG, VCA-IgA and EA-IgA all show the clinical value for NPC diagnosis, and combined detection for Rta-IgG, VCA-IgA and EA-IgA is more suitable to screen NPC and can improve the sensitivity and specificity of NPC diagnosis.

关 键 词：鼻咽肿瘤 疱疹病毒4型 人 抗体 病毒 

分 类 号：R739.63[医药卫生—肿瘤]