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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(P<0.01)。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(P>0.05)。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。
OBJECTIVE: To analyze the quantitative level of plasma EBV-DNA and the results of endoscopy in high-risk population of nasopharyngeal carcinoma and to explore the value of EBV-DNA detection in high-risk population of nasopharyngeal carcinoma in nasal endoscopy. Methods: Nasopharyngeal carcinoma (NSCLC) was screened in healthy population of Zhongshan City in the high risk area of nasopharyngeal carcinoma. EBV antibody was detected by ELISA, and 427 cases of high risk population of NPC were identified. Fluorescent quantitative PCR was used to detect the plasma levels of EBV-DNA in this population. Nasal endoscopy was performed at the same time and followed up for 1 year. Plasma Epstein-Barr virus DNA level and nasopharyngeal biopsy under endoscopy were compared and analyzed. Results: The nasopharyngeal biopsy rate was 90.2% (55/61) in EBV-DNA positive population and 60.7% (37/61) in EBV-DNA positive population at 427 nasopharyngeal carcinomas. EBV-DNA negative Nasopharyngeal biopsy rate was 13.9% (51/366) in humans and 3.3% (12/366) in nasopharyngeal carcinoma. Nasopharyngeal biopsy rate was 91.2% (31/34) in EBV-DNA positive population and 17.6% (6/34) in EBV-DNA negative population. Nasopharyngeal biopsy rate in EBV-DNA negative population was 11.9% (30/252), the detection rate of nasopharyngeal carcinoma was 1.6% (4/252). The nasopharyngeal biopsy rate and the detection rate of nasopharyngeal carcinoma in EBV-DNA-positive population during primary screening and follow-up were significantly higher than those in EBV-negative population (P <0.01). The positive predictive value of high risk nasopharyngeal carcinoma in the diagnosis of nasopharyngeal carcinoma was 8.3% (59/713). On the basis of this, the positive predictive value of EBV-DNA was increased to 45.3% (43/95). The positive rates of NPC were 79.1% (34/43) and 93.8% (15/16) respectively in EBV-DNA positive and negative groups, there was no significant difference in the rate of early diagnosis of NPC between EBV-DNA positive group and negative group (P> 0.05). Conclusion: The positive plasma EBV-DNA in nasopharyngeal carcinoma may indicate the key population of endoscopic nasopharyngeal biopsy, which is of guiding significance to endoscopic nasopharyngeal biopsy, which can greatly enhance the positive predictive value of nasopharyngeal carcinoma in high-risk population. EBV-DNA positive patients in high-risk groups are the focus of attention during the follow-up of NPC screening.