本文選題：鼻咽癌 + 篩查　； 參考：《臨床耳鼻咽喉頭頸外科雜志》2017年10期

【摘要】：目的:分析鼻咽癌高危人群血漿中EBV-DNA的定量水平和鼻內(nèi)鏡檢查結(jié)果,探討鼻咽癌高危人群EBV-DNA檢測(cè)在鼻內(nèi)鏡檢查中的應(yīng)用價(jià)值。方法:在鼻咽癌高發(fā)區(qū)中山市健康人群中進(jìn)行鼻咽癌篩查,用ELISA法檢測(cè)EBV抗體,確定鼻咽癌高危人群427例。熒光定量PCR方法檢測(cè)該人群血漿EBV-DNA水平,同時(shí)進(jìn)行鼻內(nèi)鏡檢查,并隨訪1年,比較分析高危人群血漿EBV-DNA水平與鼻內(nèi)鏡下鼻咽活檢情況。結(jié)果:初篩427例鼻咽癌高危人群中,EBV-DNA陽(yáng)性人群鼻咽活檢率為90.2%(55/61),鼻咽癌檢出率為60.7%(37/61);EBV-DNA陰性人群鼻咽活檢率為13.9%(51/366),鼻咽癌檢出率為3.3%(12/366)。隨訪286例高危人群中,EBV-DNA陽(yáng)性人群鼻咽活檢率為91.2%(31/34),鼻咽癌檢出率為17.6%(6/34);EBV-DNA陰性人群鼻咽活檢率為11.9%(30/252),鼻咽癌檢出率為1.6%(4/252)。初篩和隨訪EBV-DNA陽(yáng)性人群鼻咽活檢率和鼻咽癌檢出率均顯著高于EBV陰性人群,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。以鼻咽癌高危評(píng)定診斷鼻咽癌的陽(yáng)性預(yù)測(cè)值為8.3%(59/713),而在此基礎(chǔ)上增加EBV-DNA檢測(cè),其陽(yáng)性預(yù)測(cè)值提高至45.3%(43/95)。EBV-DNA陽(yáng)性和陰性人群中鼻咽癌早診率分別為79.1%(34/43)和93.8%(15/16),兩者早診率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:鼻咽癌高危人群血漿EBV-DNA陽(yáng)性可提示鼻內(nèi)鏡檢查的重點(diǎn)人群,對(duì)鼻內(nèi)鏡下行鼻咽活檢術(shù)有一定的指導(dǎo)意義,可大大提高鼻咽癌高危人群陽(yáng)性預(yù)測(cè)值。高危人群中EBV-DNA陽(yáng)性者是鼻咽癌篩查隨訪中需重點(diǎn)關(guān)注的對(duì)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.
【作者單位】： 中山市人民醫(yī)院耳鼻咽喉科;中山市腫瘤研究所;
【基金】：2014年廣東省中山市科技局基金資助項(xiàng)目(No:2014A1FC064)
【分類號(hào)】：R739.63

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