【摘要】 背景与目的:有报道,测定血浆中的EB病毒游离DNA(EBV-DNA)的拷贝数可作为诊断及监测鼻咽癌患者病情变化的手段之一。本研究旨在评价血浆EBV-DNA检测在鼻咽癌患者预后监测上的价值,并进一步与VCA/IgA、EA/IgA进行比较。方法:比较鼻咽癌放疗后30例远处转移患者、22例局部复发患者、24例无瘤生存者血浆中EBV-DNA、VCA/IgA、EA/IgA水平。分别应用荧光定量PCR方法检测血浆EBV-DNA水平,免疫酶法检测VCA/IgA、EA/IgA;前瞻性观察20例初诊鼻咽癌患者放疗前、放疗剂量达40Gy时及放疗结束时上述指标的变化。结果:放疗后各组不同预后患者的血浆EBV-DNA含量的中位数有显著性差异,远处转移组为135100copies/ml(四分线区域5525～1003750copies/ml)>局部复发组的20500(四分线区域0～58500copies/ml)>无瘤生存组的0copy/ml(四分线区域0～0copy/ml),P均<0.05。远处转移组的血浆EBV-DNA水平高者较多,当阳性标准为1000000copies/ml时,诊断远处转移组的敏感性为27.3%,而诊断局部复发组的敏感性为0.0%,特异性均为100.0%。在初诊患者放疗前、放疗剂量达40Gy时及放疗结束时,EBV-DNA水平逐渐降低,平均含量分别为32050copies/ml(四分线区域3880～317750copies/ml)、0copy/ml(四分线区域0～14375copies/ml)、0copy/ml(四分线区域0～2更多还原

【Abstract】 BACKGROUND &OBJECTIVE:It has been reported that cell free Epstein Barr virus (EBV DNA) in plasma was useful in diagnosing and monitoring nasopharyngeal carcinoma (NPC). The current study was designed to evaluate the significance of EBV DNA in monitoring the prognosis of nasopharyngeal carcinoma and to compare with VCA/IgA and EA/IgA. METHODS: EBV DNA, VCA/IgA,and EA/IgA levels in plasma were detected in different NPC patients after radiotherapy, including 30 distant metastasis patients, 22 locoregional recurrence patients, 24 remission individuals who had been followed up more than 2 years after treatment. EBV DNA was detected using real time quantitative PCR system;VCA/IgA and EA/IgA were tested using regular immunofluorescence. In cohort study, the indexes were tested in different radiation periods for the 20 new cases of nasopharyngeal carcinoma. RESULTS: The median plasma EBV DNA concentration was 135,100 copies/ml (interquartile range: 5,525-1,003,750) in metastasis group, 20,500 copies/ml (interquartile range: 0-58,500) in locoregional recurrence group and 0 copies/ml (interquartile range: 0-0) in continuous remission group (P< 0.05). The levels of VCA/IgA and EA/IgA had no significant difference in different groups. The high level of EBV DNA concentration in metastasis group was more than that in locoregional recurrence group. At the level of 1 000 000 copies/ml, EBV DNA indicated distant metastasis of NPC with a specificity of 100%and a sensitivity of 27.3%; however, the sensitivity was 0 copies/ml in locoregional recurrence group. For the 20 new patients, EBV DNA concentration gradually decreased in the radiation period, 32,050 copies/ml (interquartile range: 3,880-317,750) before radiation, 0 copies/ml (interquartile range: 0-14,375) when 40 Gy radiation dose and 0 copies/ml (interquartile range: 0-2940) when the radiation finished (P< 0.05). However, the levels of VCA/IgA and EA/IgA had no significant difference. CONCLUSION: The plasma cell free EBV DNA is more valuable than VCA/IgA and EA/IgA for monitoring the prognosis of NPC patients.更多还原