鼻咽癌高危人群血浆EBV-DNA检测在鼻内镜检查中的意义  

The value of plasma EBV-DNA testing in high-risk group of nasopharyngeal carcinoma in the nasal endoscopy

作　　者：何秀芳[1] 俞霞 季明芳 傅敏仪[1] 

机构地区：[1]中山市人民医院耳鼻咽喉科,广东中山5284032 [2]中山市肿瘤研究所

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第10期770-773,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：2014年广东省中山市科技局基金资助项目(No:2014A1FC064)

摘　　要：目的:分析鼻咽癌高危人群血浆中EBV-DNA的定量水平和鼻内镜检查结果,探讨鼻咽癌高危人群EBV-DNA检测在鼻内镜检查中的应用价值。方法:在鼻咽癌高发区中山市健康人群中进行鼻咽癌筛查,用ELISA法检测EBV抗体,确定鼻咽癌高危人群427例。荧光定量PCR方法检测该人群血浆EBV-DNA水平,同时进行鼻内镜检查,并随访1年,比较分析高危人群血浆EBV-DNA水平与鼻内镜下鼻咽活检情况。结果:初筛427例鼻咽癌高危人群中,EBV-DNA阳性人群鼻咽活检率为90.2%(55/61),鼻咽癌检出率为60.7%(37/61);EBV-DNA阴性人群鼻咽活检率为13.9%(51/366),鼻咽癌检出率为3.3%(12/366)。随访286例高危人群中,EBV-DNA阳性人群鼻咽活检率为91.2%(31/34),鼻咽癌检出率为17.6%(6/34);EBV-DNA阴性人群鼻咽活检率为11.9%(30/252),鼻咽癌检出率为1.6%(4/252)。初筛和随访EBV-DNA阳性人群鼻咽活检率和鼻咽癌检出率均显著高于EBV阴性人群,差异有统计学意义(P<0.01)。以鼻咽癌高危评定诊断鼻咽癌的阳性预测值为8.3%(59/713),而在此基础上增加EBV-DNA检测,其阳性预测值提高至45.3%(43/95)。EBV-DNA阳性和阴性人群中鼻咽癌早诊率分别为79.1%(34/43)和93.8%(15/16),两者早诊率差异无统计学意义(P>0.05)。结论:鼻咽癌高危人群血浆EBV-DNA阳性可提示鼻内镜检查的重点人群,对鼻内镜下行鼻咽活检术有一定的指导意义,可大大提高鼻咽癌高危人群阳性预测值。高危人群中EBV-DNA阳性者是鼻咽癌筛查随访中需重点关注的对象。Objective：The aim of this study is to evaluate the level of plasma EBV DNA and nasal endoscopy in high risk population of nasopharyngeal carcinoma,and to explore the value of EBV DNA testing in nasal endos- copy. Method：The nasopharyngeal carcinoma was screened in High-incidence Area of Zhongshan City. EBV anti- body was detected by ELISA, and 427 patients with high risk of nasopharyngeal carcinoma were identified. In the high risk population the plasma EBV-DNA was measured using Fluorescent quantitative PCR, and all patients were used nasal endoscopy in the first two years. The application value of EBV DNA and nasopharyngeal endo- scopic biopsy were analyzed. Result：There were 427 NPC high risk population in first screening. The rates of naso- pharyngeal biopsy in EBV DNA positive and EBV DNA negative population were 90.2% （55/61 ） and 13.9% （51/ 366）, respectively. The rate of NPC nasopharyngeal biopsy in EBV DNA positive population was higher than that in EBV DNA negative population（P〈0.01）. The rate of NPC detection in EBV DNA positive group（60.7% ） was higher than that（3.3%） in EBV DNA negative population （P〈0.01. In first year follow-up,there were 286 NPC high risk population. The rates of nasopharyngeal biopsy in EBV DNA positive and EBV DNA negative population were 91.2 %（31/34） and 11.9%（30/252）, respectively. The rate of NPC nasopharyngeal biopsy in EBV DNA- positive population was higher than that in EBV DNA negative population（P〈0.01. The rate of NPC detection in EBV-DNA- positive group（17.6%） was higher than that（1.6%）in EBV DNA negative population （P〈0.01. The positive predicative value of serological risk assessment was 8.3 % （59/713）, but for NPC high risk group, adding quantitative analysis of plasma EBV DNA, the positive predicative value was 45.3 % （43/95）. The early diagnosis rates in EBV DNA positive and EBV DNA negative population were 79.1% （34/43）and 93.8% （15/16, respec- tively. There was no significant difference in ea

关 键 词：鼻咽癌 筛查 高危人群 EBV-DNA 鼻内镜 

分 类 号：R739.6[医药卫生—肿瘤]