EB病毒抗体筛查对体检人群早期鼻咽癌的诊断价值  

Diagnostic value of Epstein-Barr virus antibodies screening for early nasopharyngeal carcinoma in physical examination population

作　　者：李卫[1] 黄定贵[1] 瞿申红[2] 何祺 张伶 赖丽平 刘斐[3] LI Wei;HUANG Ding-gui;QU Shen-hong;HE Qi;ZHANG Ling;LAI Li-ping;LIU Fei(Health Management Center,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China;Department of Otolaryngology&Head and Neck,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China;Research Center of Medical Sciences,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院健康管理中心,南宁市530021 [2]广西壮族自治区人民医院耳鼻咽喉头颈科,南宁市530021 [3]广西壮族自治区人民医院科研实验中心,南宁市530021

出　　处：《广西医学》2020年第18期2404-2408,共5页Guangxi Medical Journal

基　　金：国家自然科学基金(81960493);广西医药卫生科研课题(Z20180759)。

摘　　要：目的探讨3种EB病毒抗体[R反式激活因子(Rta)-IgG、早期抗原(EA)-IgA和病毒衣壳抗原(VCA)-IgA]筛查对体检人群早期鼻咽癌的诊断价值。方法联用Rta-IgG、EA-IgA和VCA-IgA对22651例体检人群进行筛查,有一项及以上指标阳性者判定为EB病毒血清学阳性。随访观察EB病毒血清学阳性者的临床表现,对有可疑病灶者进行病理活检及影像学检查以确诊早期鼻咽癌。分析不同性别、不同年龄体检者的Rta-IgG、VCA-IgA和EA-IgA阳性检出率,以及EB病毒血清学阳性者Rta-IgG、VCA-IgA和EA-IgA三联检的阳性分布情况。根据EB病毒抗体情况对体检人群EB病毒血清学阳性者进行分层评估:Rta-IgG、EA-IgA和VCA-IgA 3项检测指标均阳性为高危组,其中2项指标阳性为中危组,仅1项指标阳性为低危组。结果22651例体检者中共筛查出EB病毒阳性1631例,总阳性率为7.20%,其中女性阳性率(8.04%)高于男性(6.62%)(P<0.05)。不同年龄组体检者Rta-IgG、EA-IgA和VCA-IgA的阳性检出率差异有统计学意义(P<0.05),60岁以后以上3种血清学指标的阳性检出率均明显升高。在单项指标阳性中,VCA-IgA的阳性检出率较高(56.65%),且30~40岁、51~60岁和61~70岁年龄组女性的VCA-IgA阳性检出率高于男性(P<0.05);在不同组合指标阳性中,Rta-IgG+VCA-IgA的阳性检出率较高(7.91%)。鼻咽癌低、中、高危组分别有1399例、220例、12例,分别追踪到0例、15例、11例鼻咽癌,其中Rta-IgG+VCA-IgA双阳性筛检出12例,3种抗体均阳性筛检出11例。结论联合检测Rta-IgG、EA-IgA和VCA-IgA可从体检者中有效筛查出EB病毒阳性人群,其中具有双阳性或三阳性人群的患癌风险较高,重点随访该类人群,有助于提高鼻咽癌早诊早治效果。Objective To explore the diagnostic value of screening three antibodies of Epstein-Barr virus,R transactivator(Rta)-IgG,early antigen(EA)-IgA and viral capsid antigen(VCA)-IgA,for early nasopharyngeal carcinoma(NPC)in physical examination population.Methods The combination of Rta-IgG,EA-IgA and VCA-IgA was applied to a screening in 22651 physical examination individuals,and those with one or more positive indices were identified as being serologically positive for Epstein-Barr virus.A follow-up and observation on clinical manifestation was performed in individuals tested serologically positive for Epstein-Barr virus,pathological biopsy and radiological examination were conducted in individuals with suspected lesions to identify early NPC.The positive rates of Rta-IgG detection,VCA-IgA detection,and EA-IgA detection were analyzed in physical examination population of different gender or with different age,and the distribution of positive condition for the combined detection of Rta-IgG,VCA-IgA and EA-IgA was analyzed in individuals tested serologically positive for Epstein-Barr virus.A stratified assessment was performed on physical examination individuals tested serologically positive for Epstein-Barr virus based on the condition of Epstein-Barr virus antibodies:those tested positive for all of the three detection indices(Rta-IgG,EA-IgA and VCA-IgA)were enrolled as high-risk group,those tested positive for two indices as moderate-risk group,and those tested positive for single index as low-risk group.Results A total of 1631 Epstein-Barr virus-positive cases were screened out from 22651 physical examination individuals,with a total positive rate of 7.20%,in which female positive rate was higher than male rate(8.04%vs.6.62%,P<0.05).There were statistically significant differences in positive detection rates of Rta-IgG,EA-IgA and VCA-IgA between physical examination population in different age groups(P<0.05),and people older than 60 years exhibited a remarkable increase in positive detection rates of the three serolo

关 键 词：鼻咽癌 EB病毒抗体 R反式激活因子-IgG 早期抗原-IgA 病毒衣壳抗原-IgA 筛查 早期诊断 广西 体检人群 诊断 

分 类 号：R739.6[医药卫生—肿瘤]