鼻咽癌高危人群血浆EBV-DNA检测在鼻内镜检查中的意义

发布时间：2018-06-23 20:04

本文选题：鼻咽癌 + 筛查　；参考：《临床耳鼻咽喉头颈外科杂志》2017年10期

【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(P0.01)。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(P0.05)。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。
[Abstract]:Objective: to analyze the quantitative level of EBV-DNA in plasma and the results of nasal endoscopy in high risk population of nasopharyngeal carcinoma (NPC), and to explore the value of EBV-DNA detection in nasal endoscopy. Methods: NPC screening was carried out in healthy population of Zhongshan City in high incidence area of nasopharyngeal carcinoma. The EBV antibody was detected by Elisa. 427 cases of high risk population of nasopharyngeal carcinoma were identified. The plasma EBV-DNA level was detected by fluorescence quantitative PCR, and nasal endoscopy was performed. The plasma EBV-DNA level and nasopharyngeal biopsy were compared with those of high risk population for one year. Results: the nasopharyngeal biopsy rate was 90.2% (55 / 61) in patients with positive EBV-DNA, 60.7% (37 / 61) with negative EBV-DNA, 13.9% (51 / 366) with nasopharyngeal carcinoma and 3.3% (12 / 366) with nasopharyngeal carcinoma. The nasopharyngeal biopsy rate was 91.2% (31 / 34) in patients with EBV-DNA positive, 17.6% (6 / 34) in patients with negative EBV-DNA, and 1.6% (4252%) in nasopharyngeal carcinoma. The nasopharyngeal biopsy rate and the detection rate of nasopharyngeal carcinoma in EBV-DNA positive group were significantly higher than those in EBV negative group (P0.01). The positive predictive value of nasopharyngeal carcinoma diagnosed by high risk assessment was 8.3% (59 / 713), and the positive predictive value of EBV-DNA was increased to 45.3% (43 / 95). The early diagnosis rate of nasopharyngeal carcinoma was 79.1% (34 / 43) and 93.8% (15 / 16), respectively. There was no significant difference between the two groups (P0.05). Conclusion: plasma EBV-DNA positive in high risk population of nasopharyngeal carcinoma may indicate the key population of nasal endoscopy. It has certain guiding significance for nasopharyngeal biopsy under nasal endoscopy, and can greatly improve the positive predictive value of high risk population of nasopharyngeal carcinoma. EBV-DNA positive individuals in high-risk population are the focus of attention during NPC screening and follow-up.
【作者单位】：中山市人民医院耳鼻咽喉科;中山市肿瘤研究所;
【基金】：2014年广东省中山市科技局基金资助项目(No:2014A1FC064)
【分类号】：R739.63

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