鼻咽脱落细胞EB病毒DNA在鼻咽癌诊断中的价值  

Value of Epstein-Barr virus DNA in nasopharyngeal exfoliated cells in diagnosis of nasopharyngeal carcinoma

作　　者：陈耿杭 谢尚杭 林初阳 卢玉强[3] 黄启洪 柳青[2] 曹素梅[2] CHEN Geng-hang;XIE Shang-hang;LIN Chu-yang;LU Yu-qiang;HUANG Qi-hong;LIU Qing;CAO Su-mei(School of Public Health,Sun Yat-sen University,Guangzhou,Guangdong 510080;Department of Cancer Prevention,Sun Yat-sen University Cancer Center,Guangzhou.Guangdong 510080;Cancer Research Center of Sihui City,Sihui,Guangdong 526200,China)

机构地区：[1]中山大学公共卫生学院,广东广州510080 [2]中山大学肿瘤防治中心肿瘤预防研究部,广东广州510080 [3]广东省四会市惠民平价门诊部四会市肿瘤研究所,广东四会526200

出　　处：《热带医学杂志》2020年第3期332-335,共4页Journal of Tropical Medicine

基　　金：国家重点研发计划项目(2017YFC0907102);广东省科技计划项目(2017A020215033);中山大学临床医学研究5010计划项目(2013012)。

摘　　要：目的探讨检测鼻咽脱落细胞EB病毒(EBV)DNA在鼻咽癌早期诊断中的价值。方法利用鼻咽癌筛查队列开展巢式病例对照研究。收集2014年1月-2018年11月广东省四会市鼻咽癌筛查队列发现的23例鼻咽癌为病例组,在未检出癌的筛查人群中按年龄、性别匹配后,随机抽取92例作为对照组,应用荧光定量PCR检测鼻咽脱落细胞中的EBV EBNA1基因拷贝数作为EBV DNA载量的评价指标,比较鼻咽癌组与对照组EBV DNA载量及不同分期鼻咽癌EBV DNA载量,并进一步比较其与EBV血清抗体对鼻咽癌的诊断效果。结果鼻咽癌组鼻咽脱落细胞中EBV DNA中位数3.1×10^5拷贝/鼻咽刷,显著高于对照组0拷贝/鼻咽刷(P<0.001),并与肿瘤分期呈正相关。EBV DNA诊断效能与血清抗体差异无统计学意义(P>0.05),曲线下面积(AUC)分别为0.876(0.786~0.966)和0.915(0.859~0.972);而EBV DNA对早期鼻咽癌诊断优于血清抗体。EBV DNA与抗体联合诊断时,敏感度为82.6%(60.5%~94.3%),而筛查特异度显著提高,达90.2%(81.8%~95.2%)。结论鼻咽脱落细胞EBV DNA是良好的诊断指标,同时联合血清抗体检测可以显著提高筛查效能。Objective To evaluate the value of detecting Epstein-Barr virus DNA in nasopharyngeal exfoliated cells in early diagnosis of nasopharyngeal carcinoma(NPC).Methods A nested case-control study was conducted based on a NPC screening cohort.23 NPC cases found in the NPC screening cohort of Sihui city,Guangdong Province from January to November 2018 were collected.After matching for age and sex in the non-cancerous screening population,92 participants were randomly selected as the control group.Quantitative PCR was used to detect the EBV EBNA1 gene copy number in nasopharyngeal exfoliated cells as an indicator of EBV DNA load.The EBV DNA load of the NPC group and the control group and the EBV DNA load of different stages of NPC were compared.Further,we compared the performance of EBV DNA with EBV serum antibody for the diagnosis of NPC.Results In NPC group,the median EBV DNA load in the nasopharyngeal exfoliated cells was 3.1×10^5 copies/swab,which was significantly higher than that of the control group with 0 copies/swab,P<0.001;the EBV DNA load was positively correlated with tumor stage.There was no significant difference between EBV DNA diagnostic efficacy and serum antibody,with AUC 0.876(0.786-0.966)and 0.915(0.859-0.972),respectively,P=0.358.EBV DNA was superior to serum antibody in the early diagnosis of NPC.When combined with EBV DNA and antibody,the sensitivity was 82.6%(60.5%-94.3%),while the screening specificity was significantly increased to 90.2%(81.8%-95.2%).Conclusion EBV DNA in nasopharyngeal exfoliated cells should be a good diagnostic indicator,and combined with serum antibody screening could significantly improve efficiency in NPC screening.

关 键 词：鼻咽癌 鼻咽脱落细胞EBV DNA 荧光定量PCR 

分 类 号：R739.63[医药卫生—肿瘤]