EB病毒抗体联合检测在临沂地区鼻咽癌筛查中的应用研究

Application of combined detection of Epstein-Barr virus antibodies in nasopharyngeal carcinoma screening in Linyi area

摘要:

目的 评估EB病毒相关血清学标志物Rta蛋白IgG抗体(Rta/IgG)、衣壳抗原IgA抗体(VCA/IgA)、早期抗原IgA抗体(EA/IgA)联合检测在临沂地区鼻咽癌(NPC)筛查中的应用价值。方法 收集2019年10月—2022年10月在临沂市人民医院体检的体检组15 873例、有鼻咽部相关临床症状的筛查组1 800例、经病理科确诊为NPC的确诊组48例研究对象的临床资料，采用酶联免疫法分别检测其血清中Rta/IgG、VCA/IgA、EA/IgA的抗体水平，将检测结果绘制成ROC曲线并进行统计学分析，评价3项指标单独检测及联合检测对NPC的诊断价值。结果 Rta/IgG、VCA/IgA、EA/IgA在确诊组阳性率分别为72.90%(35/48)、85.41%(41/48)、85.41%(41/48)，在筛查组阳性率分别为17.17%(309/1 800)、27.06%(487/1 800)、17.72%(319/1 800)，在体检组阳性率分别为10.34%(1 642/15 873)、19.30%(3 070/15 873)、9.96%(1 581/15 873)。确诊组阳性率明显高于筛查组(χ²分别为95.918、78.029、136.589)及体检组(χ²分别为198.823、132.894、297.787),差异均具有统计学意义(P均<0.01)；Rta/IgG、VCA/IgA、EA/IgA的灵敏度分别为72.90%、85.41%、85.41%，特异度分别为89.0%、79.9%、89.2%。3项抗体联合检测时其灵敏度及特异度分别为95.83%(46/48)和99.12%(17 518/17 673)；且ROC曲线下面积AUC为0.949，均高于3项抗体单独检测值(0.846、0.901、0.916)。结论 Rta/IgG、VCA/IgA、EA/IgA抗体的联合检测可更大范围的反应EB病毒潜伏期及溶解期的抗原表达，具有很好的互补作用，明显提高了NPC的检出率。

关键词:鼻咽肿瘤;疱疹病毒4型,人;抗体;诊断

Abstract:

Objective To evaluate the value of combination detection of serological Epstein-Barr virus (EBV) markers Rta protein IgG antibody (Rta/IgG), capsid antigen IgA antibody (VCA/IgA), early antigen IgA antibody (EA/IgA) in nasopharyngeal carcinoma (NPC) screening in Linyi area.Methods Clinical data of 15 873 subjects in physical examination group, 1 800 subjects in screening group with nasopharyngeal symptoms and 48 subjects in confirmed NPC group in People’s Hospital of Linyi City from October 2019 to October 2022, were collected. The serum levels of EBV Rta/IgG, VCA/IgA and EA/IgA were detected by euzymelinked immunosorbent assay in all the patients. Statistical analyses were performed with receiver operating characteristic curve to evaluate the diagnostic values of the three indexes and combined detection for NPC.Results The positive rates of Rta/IgG,VCA/IgA and EA/IgA in the confirmed NPC group were 72.90% (35/48), 85.41% (41/48), 85.41% (41/48), respectively. In the screening group, their positive rates were 17.17% (309/1 800), 27.06% (487/1800), and 17.72% (319/1 800), and those in the physical examination group were 10.34% (1 642/15 873),19.30% (3 070/15 873) and 9.96% (1 581/15 873), respectively. Their positive rates of the confirmed NPC group were significantly higher than those of the screening group(χ²=95.918,78.029 and 136.589, all P<0.01) and those of the physical examination group (χ²=198.823, 132.894 and 297.787, all P<0.01). The differences were all statistically significant. Sensitivities of Rta/IgG,VCA/IgA and EA/IgA detection were 72.90%, 85.41%, and 85.41%, respectively, while the specificities were 89.0%, 79.9% and 89.2%, respectively. The sensitivity and specificity of the combination detection of the three antibodies were 95.83% (46/48) and 99.12% (17 518/17 673), respectively. And the area under the ROC of the combination detection was 0.949, which was higher than those of the three antibodies alone (0.846,0.901 and 0.916).Conclusion The combined detection of Rta/IgG, VCA/IgA and EA/IgA can expand the detection range of the antigen expression in the latency and lysis period of EBV, which has a good complementary effect and significantly improves the detection rate of NPC.

Key words:Nasopharyngeal neoplasms;Herpesvirus 4,Human;Antibodies;Diagnosis