咽后淋巴结转移鼻咽癌患者血浆EBV DNA和血清EB抗体与预后的关系  

Relationship of plasma EBV DNA and serum EBV antibodies with prognosis in patients with nasopharyngeal carcinoma with retropharyngeal lymph node metastasis

作　　者：叶倩[1] 万鑫蕊 宗井凤[2] 陈岩松[1] 崔兆磊[1] 陈燕[3] Qian Ye;Xin-RuiWan;Jing-feng Zong;Yan-song Chen;Zhao-lei Cui;Yan Chen(Department of Clinical Laboratory,Fujian Medical University Cancer Hospital(Fujian Cancer Hospital),Fuzhou,Fujian 350014,China;Department of Radiation Oncology,Fujian Medical University Cancer Hospital(Fujian Cancer Hospital),Fuzhou,Fujian 350014,China;Laboratory of Biochemistry and Molecular Biology Research,Fujian Medical University Cancer Hospital(Fujian Cancer Hospital),Fuzhou,Fujian 350014,China)

机构地区：[1]福建医科大学附属肿瘤医院(福建省肿瘤医院)检验科,福建福州350014 [2]福建医科大学附属肿瘤医院(福建省肿瘤医院)放疗科,福建福州350014 [3]福建医科大学附属肿瘤医院(福建省肿瘤医院)生物化学分子生物学研究室,福建福州350014

出　　处：《中国现代医学杂志》2021年第14期52-59,共8页China Journal of Modern Medicine

基　　金：福建省自然科学基金(No:2018J01273)。

摘　　要：目的探讨咽后淋巴结转移鼻咽癌(NPC)患者血浆Epstein-Barr病毒(EBV)DNA和血清EB病毒衣壳抗原IgA抗体(VCA-IgA)、EB病毒早期抗原IgA抗体(VEA-IgA)与疗效、预后的关系。方法回顾分析139例咽后淋巴结转移NPC患者的临床资料,用qRT-PCR法检测血浆EBV-DNA水平,酶联免疫吸附试验检测EB病毒VCA-IgA、VEA-IgA水平,根据疗效评价分为缓解组和进展组,比较治疗前后三项指标水平差异,分析治疗前各指标与临床预后、总生存的关系,Kaplan-Meier法计算生存率,Cox回归模型进行预后因素分析。结果不同T分期、N分期和临床分期的EBV DNA浓度,差异有统计学意义(P<0.05)。不同临床分期VCAIgA浓度和VEA-IgA浓度比较,差异有统计学意义(P<0.05),不同年龄、性别的EBV DNA浓度、VCA-IgA浓度和VEA-IgA浓度比较,差异无统计学意义(P>0.05)。咽后淋巴结转移NPC患者治疗前后血浆EBV DNA浓度比较,差异有统计学意义(P<0.05),治疗前后VCA-IgA浓度和VEA-IgA浓度比较,差异无统计学意义(P<0.05)。缓解组与进展组治疗前后EBV DNA差值比较,差异有统计学意义(P<0.05),VCA-IgA和VEA-IgA差值比较,差异无统计学意义(P>0.05)。患者4年总生存率为72.7%,T_(1)期、T_(2)期、T_(3)期、T4期的4年总生存率分别为89.5%、80.8%、71.4%和59.6%,差异有统计学意义(P<0.05),有无远处转移、是否疾病进展和是否复发患者中位生存期和4年生存率比较,差异有统计学意义(P<0.05)。多因素Cox回归模型分析结果表明:临床分期[HR=2.162(95%CI:1.130,3.215),P<0.05]、EBV DNA水平[HR=2.324(95%CI:1.242,5.529),P<0.05]、颈部淋巴结转移侧数[HR=3.012(95%CI:0.653,5.564),P<0.05]是影响NPC生存率的危险因素。结论EBV DNA、VCA-IgA及VEA-IgA可为咽后淋巴结转移NPC患者的疗效监测、预后判断和个体化治疗提供帮助。Objective To investigate the relationship of plasma Epstein-Barr virus(EBV)DNA and serum EBV viral capsid antigen antibody(VCA-IgA)and EBV early antigen antibody(VEA-IgA)with therapeutic efficacy and prognosis in patients with nasopharyngeal carcinoma(NPC)with retropharyngeal lymph node metastasis.Methods We retrospectively analyzed 139 cases of NPC patients with retropharyngeal lymph node metastasis.The real-time fluorescent quantitative PCR was applied to detect the plasma EBV DNA level,while enzyme-linked immunosorbent assay was used to determine EBV VCA-IgA and VEA-IgA levels.According to the curative effect,the patients were divided into remission group and progression group,and the changes in the levels of these indexes before and after the treatments were compared.The relationship of the levels of these indexes with the prognosis and overall survival was analyzed,with survival rate calculated via Kaplan-Meier method and prognostic factors analyzed via Cox regression model.Results The concentrations of EBV DNA differed among different T stages,N stages and clinical stages(P<0.05),while the concentrations of EBV VCA-IgA and VEA-IgA differed among different clinical stages(P<0.05).However,the concentrations of EBV DNA,EBV VCA-IgA and VEA-IgA did not differ among patients with different age and gender(P>0.05).The concentration of EBV DNA after treatment was significantly lower than that before treatment(P<0.05),while there was no significant difference in the levels of VCA-IgA and VEA-IgA antibodies before and after treatment(P>0.05).The difference in the level of EBV DNA before and after the treatment was different between the remission group and progression group(P<0.05),while the differences in the levels of VCA-IgA and VEA-IgA antibodies before and after the treatment did not differ between the two groups(P>0.05).The 4-year overall survival rate was 72.7%,while that of patients in stage T_(1),T_(2),T_(3) and T4 was 89.5%,80.8%,71.4%,and 59.6%,respectively,with statistically significant differences(P<0.001)

关 键 词：鼻咽肿瘤 EB病毒DNA/DNA 疗效比较研究 预后 

分 类 号：R737.33[医药卫生—肿瘤]