血浆EB病毒核酸检测在非高发区鼻咽癌患者中的临床价值探讨  

Clinical value of plasma Epstein-Barr virus DNA test in patients with nasopharyngeal carcinoma in non-high-incidence area

作　　者：巫丽娟[1] 张莉[1] 赵艺 黄馨怡 周娟[1] 丁柳[1] 彭武[1] 庄杰[1] 周汶静[1] 陆小军[1] 陈捷[1] WU Lijuan;ZHANG Li;ZHAO Yi;HUANG Xinyi;ZHOU Juan;DING Liu;PENG Wu;ZHUANG Jie;ZHOU Wenjing;LU Xiaojun;CHEN Jie(Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院实验医学科,成都610041

出　　处：《华西医学》2021年第8期1032-1036,共5页West China Medical Journal

基　　金：国家自然科学基金(81873979,81401666);四川省卫生和计划生育委员会基金项目(18PJ101)。

摘　　要：目的探讨非高发区鼻咽癌患者血浆EB病毒(Epstein-Barr virus,EBV)核酸检测在临床诊断中的应用价值及其对鼻咽癌患者治疗后的监测意义。方法回顾性收集2014年1月—2015年12月确诊的非角化型鼻咽癌患者235例,分析其EBV-DNA检测率,治疗前及治疗后半年内阳性率,以及治疗后半年内血浆EBV-DNA阳性与鼻咽癌预后的关联。结果治疗前检测EBV-DNA者仅占69.79%(164/235),其中EBV-DNA阳性率为90.85%(149/164)。治疗后半年内检测EBV-DNA的患者共131例,其治疗前阳性率为89.31%(117/131),治疗后阳性率为21.37%(28/131),治疗前后差异有统计学意义(P<0.001)。治疗后半年内EBV-DNA阳性患者与阴性患者比较,其3年复发率差异无统计学意义(10.71%vs.3.88%,P=0.341),但阳性患者3年转移率(21.43%vs.4.85%,P=0.016)及3年疾病进展率(32.14%vs.6.80%,P=0.001)均高于阴性患者。生存分析也显示,治疗后半年内EBVDNA阳性患者3年无进展生存率(67.86%vs.93.20%,P<0.001)、3年无转移生存率(78.57%vs.95.15%,P=0.004)低于阴性患者。按年龄、性别、TNM分期等因素分组,组间3年期无进展生存曲线差异均无统计学意义(P>0.05)。结论对于非高发区的非角化型鼻咽癌患者,EBV-DNA检测对于鼻咽癌的筛查及诊断具有重要意义,且治疗后半年内EBV-DNA阴阳性为患者预后及进展的重要影响因素,治疗前后都应定期监测血浆EBV-DNA水平。Objective To explore the application value of plasma Epstein-Barr virus(EBV)DNA test in the clinical diagnosis of patients with nasopharyngeal carcinoma in non-high-incidence areas of Southwest China and its significance for monitoring patients after treatment.Methods A total of 235 patients diagnosed with non-keratinized nasopharyngeal carcinoma between January 2014 and December 2015 were retrospectively collected.The plasma EBVDNA test rate of the nasopharyngeal carcinoma patients before treatment,the positive rates of the plasma EBV-DNA test before treatment and within 6 months of treatment,and the relationship between the positivity of plasma EBV-DNA within 6 months of treatment and the prognosis of nasopharyngeal carcinoma were analyzed.Results The plasma EBVDNA test rate of the nasopharyngeal carcinoma patients before treatment was 69.79%(164/235),with a positive rate of90.85%(149/164).A total of 131 patients were tested for EBV-DNA within 6 months of treatment,whose positive rate was89.31%(117/131)before treatment and 21.37%(28/131)within 6 months of treatment,respectively,with a statistically significant difference(P<0.001).Comparing the prognosis of EBV-DNA positive patients and negative patients within6 months of treatment,the difference in 3-year recurrence rate between the two groups was not statistically significant(10.71%vs.3.88%,P=0.341);however,the 3-year metastasis rate(21.43%vs.4.85%,P=0.016)and the 3-year disease progression rate(32.14%vs.6.80%,P=0.001)of the EBV-DNA positive patients were higher than those of the EBV-DNA negative patients,and the log-rank test slao showed that the 3-year progression-free survival rate(67.86%vs.93.20%,P<0.001)and the 3-year metastasis-free survival rate(78.57%vs.95.15%,P=0.004)of the EBV-DNA positive patients were lower than those of the EBV-DNA negative patients.There was no statistically significant between-group difference in the3-year progression-free survival curve when grouped by age,gender,or TNM staging(P>0.05).Conclusions For patients with non-keratini

关 键 词：鼻咽癌 EB病毒 DNA检测 预后 

分 类 号：R739.63[医药卫生—肿瘤]