304例普查人群EB病毒核抗原抗体检测的前瞻性观察

广东省是鼻咽癌最高发地区,许多实验研究已报导鼻咽癌与EB病毒有密切的关系。1980年曾毅等在广西苍梧县进行了鼻咽癌血清学普查发现测定VCA—IgA抗体可以发现早期鼻咽癌,同时亦证明EA—IgA抗体对鼻咽癌也较为特异。测定EB病毒核抗原(EBNA)的抗补体免疫酶法     

488683人鼻咽癌普查基本方案分析

目的分析488 683人鼻咽癌普查结果,其中20 726人是广西梧州市鼻咽癌高发现场1980年普查及10年追踪观察和对查出EB病毒IgA/VCA抗体阳性者20年追踪观察结果,467 957人是现场以外其它地区普查结果,两者结果比较分析提出鲻鼻咽癌普查和社区应用基本方案.方法应用免疫酶法检测EB病毒IgA/VCA抗体,间接鼻咽镜配合,在现场和现场以外其它地区进行鼻咽癌普查.结果现场20 726人普查及10年和20年追踪观察,IgA/VCA抗体阴性19 590人10年内发生鼻咽癌4例,其中3例确诊时IgA/VCA抗体已显阳性反应,仅1例仍为阴性,IgA/VCA抗体阳性1 136人普查及20年追踪观察检出鼻咽癌60例,其中接受随访的54例中,有46例属早期,早诊率85.2%,IgA/VCA抗体诊断鼻咽癌符合率98.3%.现场以外其它地区普查467 957人,检出鼻咽癌188例,其中属于早期患者为164例,早诊率87.2%,可以重复现场结果.结论免疫酶法检测EB病毒IgA/VCA抗体普查鼻咽癌,间接鼻咽镜配合,方法简单、价廉、诊断符合率高,可以检出鼻咽癌早期病人,是鼻咽癌普查或社区服务的首选基本方案,其它抗体检测可在这基础上互补,符合成本效益卫生经济学观点.     

间接鼻咽镜在社区鼻咽癌血清学普查中的应用价值

目的 :通过社区鼻咽癌EB病毒血清学普查发现EB病毒抗体阳性人群 ,从抗体阳性者中发现早期鼻咽癌患者。方法 :社区血清学普查检出EB病毒抗体 (VCA IgA)阳性者 ,并应用间接鼻咽镜检查鼻咽部 11977人 ,发现异常即取组织送病理检查。结果 :病理确诊 174例 ,早期 15 1例 ,早诊率 86 78% ,鼻咽原发灶位于顶后壁 95例占 5 4 60 % ,侧壁 60例占 34 4 % ,前壁 1例占 0 5 7%最少 ;68例原发灶直径 <0 5cm占 39 0 8%。结论 :鼻咽癌血清学普查作为初筛的手段 ,可以得出鼻咽癌的高危人群。间接鼻咽镜的应用 ,可以检出鼻咽癌临床早期患者 ,适用于社区 ,特别是农村和边远地区大人群普查     

广西梧州市居民的鼻咽癌血清学普查

在广西梧州市进行了鼻咽癌的血清学普查,从年龄为40～59的居民12932人采血。VCA/IgA抗体的阳性率为5.3％,EA/IgA抗体的阳性率为VCA/IgA抗体阳性者的4.4％。VCA/IgA抗体阴性者的EA/IgA抗体也是阴性。从VCA/IgA抗体阳性者中检查出13例鼻咽癌,其中9例的EA/IgA抗体也是阳性。12932人群中的鼻咽癌检出率为100.5/10万,VCA/IgA抗体阳性者的鼻咽癌检出率为1900/10万,分别较1975—1978年同年龄组人群的年发病率高一倍和37倍。这些结果进一步证明EB病毒与鼻咽癌关系密切。13例鼻咽癌中Ⅰ期9例,占70％,Ⅱ期4例,占30％。因此,早期诊断和早期治疗可以降低病死率。     

苍梧县水上居民的鼻咽癌血清学普查

 应用免疫酶法对广西苍梧县30岁以上船民518人进行鼻咽癌血清学普查，EB病毒IgA/VcA抗体阳性18人，阳性率为3.47％，IgA/EA抗体阳性5人，阳性率为0.97％。IgA/VcA抗体阴性的血清，IgA/EA抗体也是阴性。从IgA/VcA抗体阳性者发现2例低分化的鼻咽癌病人：Ⅰ期和Ⅱ期各1例，他们的IgA/EA抗体均为阳性。经普查后船民的年发病率达61.82/10万。     

EB病毒抗体与鼻咽癌发病风险的前瞻性研究

[目的]探讨EB病毒抗体滴度变化与鼻咽癌发病风险的关系,为筛检高危人群提供依据.[方法] 1987～2007年对广东省四会市共18986名现场人群进行筛检,检测血清学EB病毒壳抗原免疫球蛋白(VCA/IgA)和早期抗原免疫球蛋白(EA/IgA)水平.采用Cox风险回归模型评估EB病毒抗体与鼻咽癌发病风险的关系.[结果] 1987～2007年共检出125例鼻咽癌.VCA/IgA和EA/IgA的血清阳性率分别为7.16％ (1318/18411)和0.24％ (45/18411).VCA/IgA阴性组鼻咽癌年龄调整发病率为29.4/10万人年,明显低于VCA/IgA阳性、EA/IgA阴性组(188.2/10万人年)和两者均阳性组(617.4/10万人年).与VCA/IgA阴性组相比,VCA/IgA阳性者抗体滴度越高,鼻咽癌发病风险越大.随访期间,EB病毒VCA/IgA抗体滴度升高者的鼻咽癌发病风险最高,在前5年的随访期间更为明显(调整HR=21.3,95％CI:7.1～64.1),抗体滴度降低者的发病风险最低(调整HR=1.5,95 ％CI:0.2～11.4).[结论]持续升高的VCA/IgA抗体滴度与鼻咽癌发病风险的增加明显相关,EB病毒VCA/IgA抗体阳性者是筛查的重点人群.     

广东省四会县12,233名成人EB病毒相关抗体的调查报告

EB病毒VCA—IgA抗体血清学普查是早期发现鼻咽癌的方法之一。我们于1983年12月在四会镇职工和邻近的清塘区农民中以30—59岁为重点,作EBV相关抗体血清学普查,共检测12,233人。该人群生活在15×10Km范围内:总人口数55,635,现分析检测结果。 材料和方法 指端微量取血法。由中国预防医科院病毒所提供VCA—IgA和EA—IgA间接免疫酶法试剂并协同我们按常规实验方法检测。VCA—IgA抗体阳性者作临床检查,可疑鼻咽癌者作病理学检查。     

鼻咽清毒颗粒合用鼻渊舒口服液治疗放疗后鼻咽癌患者的临床研究

[目的]观察鼻咽清毒颗粒合用鼻渊舒口服液对鼻咽癌患者放疗后EB病毒壳抗原抗体VCA/IgA滴度水平和鼻咽部症状的作用。[方法]将62例鼻咽癌放疗后患者按就诊时间顺序分成实验组（鼻咽清毒颗粒联合鼻渊舒口服液组）32例和对照组（鼻咽清毒颗粒组）30例。[结果]实验组和对照组治疗前EB病毒VCA/IgA几何平均滴度分别为1：86.68和1：70.63（P〉0.05）。治疗后实验组VCA/IgA几何平均滴度为1：28.07；对照组VCA/IgA几何平均滴度为1：53.90（P〈0.05）。实验组治疗后对于鼻咽部脓性分泌物的症状改善情况好于对照组。[结论]鼻咽清毒颗粒合用鼻渊舒口服液对鼻咽癌患者放疗后EB病毒VCA/IgA滴度水平有明显的抑制作用，对其鼻咽部症状有较好的改善作用。     

苍梧县EB病毒VCA—IgA阳性者的随访结果

我们在广西苍梧县进行了鼻咽癌前瞻性研究，从1978年至1979年检测了30岁以上正常人群148029人的EB病毒壳抗原免疫球蛋白A抗体（VCA－IgA），在3533例抗体阳性者中经临床和组织学检查当年发现55例鼻咽癌病人，我们对其余的抗体阳性者，继续观察，结果报告如下。材料与方法1．对象：全县148029人采血检查，VCA－IgA抗体滴度≥1：5的3533人为阳性者进行观察。2．方法：用直径1．5毫米塑料管指尖采皿，分高血清，用间接免疫酶法检查VCA－IgA抗体，抗体阳性者建卡登记，临床作鼻咽部和全身检查，可疑者取组织做病理切片确认，在石桥乡和…     

鼻咽清毒颗粒加鼻渊舒口服液抑制鼻咽癌高危人群EB病毒VCA/IgA的临床观察

目的:观察鼻咽清毒颗粒加鼻渊舒口服液对鼻咽癌高危人群EB病毒壳抗原抗体VCA/IgA的抑制作用。方法:将136例鼻咽癌高危患者按就诊顺序分成实验组(鼻咽清毒颗粒加鼻渊舒口服液组)76例和对照组(鼻咽清毒颗粒组)60例。两组在治疗前均经电子鼻咽镜检查和鼻咽部活检排除有鼻咽癌。结果:实验组和对照组治疗前EB病毒VCA/IgA几何平均滴度分别为1∶38.04和1∶30.80,两组几何平均滴度基本一致,u=1.18,P=0.320。治疗后,实验组76例患者中痊愈42例(55.3%)、显效16例(21.0%)、有效10例(13.2%)及无效8例(10.5%),未见任何不良反应;对照组60例患者中痊愈10例(16.7%)、显效4例(6.6%)、有效10例(16.7%)及无效36例(60.0%)。两组疗效比较差异有统计学意义,u=4.2,P=0.000。治疗后,对照组VCA/IgA几何平均滴度降至1∶22.15,鼻咽清毒颗粒对EB病毒VCA/IgA滴度水平影响不大,u=1.34,P=0.220;而实验组VCA/IgA几何平均滴度降至1∶8.26,鼻咽清毒颗粒加用鼻渊舒口服液能显著性降低鼻咽癌高危人群EB病毒VCA/IgA滴度水平,u=8.92,P=0.000。结论:鼻咽清毒颗粒加用鼻渊舒口服液对鼻咽癌高危人群EB病毒VCA/IgA滴度水平有明显的抑制作用,有助于降低鼻咽癌的发病率。     

鼻咽癌患者发病前后EB病毒VCA/IgA和EA/IgA滴度动态分析

目的 观察鼻咽癌患者发病前后EB病毒VCA/IgA、EA／IgA滴度的变化规律,及其在鼻咽癌筛查中的作用。方法 收集中山市首次鼻咽癌筛查后12年VCA／IgA阳性人群中54例新发鼻咽癌患者发病前后的血清学资料,用免疫酶法检测EB病毒抗体VCA/IgA和EA／IgA。结果 确诊前1～7年VCA／IgA、EA／IgA总体呈上升趋势。发病前7～4年,VCA／IgA平均滴度在1：21．04上下波动,确诊前第3年起VCA／IgA急剧上升,确诊时几何平均滴度接近1：80,EA／IgA高较为缓慢,确诊时几何平均滴度为1：6．49。放疗后两种滴度均呈快速下降趋势,第4年起接近阳性人群的平均滴度。结论 多数鼻咽癌患者在确诊前3年,VCA／IgA滴度持续增高,但EA／IgA滴度增高缓慢;VCA／IgA可以检出早期鼻咽癌,但EA／IgA作用不大;鼻咽癌发展临床前期平均时间为3年。     

Significance of Plasma IgA and IgG Antibodies to Epstein-Barr Virus Early and Viral Capsid Antigens in Thai Nasopharyngeal Carcinoma

Epstein-Barr virus (EBV) is an important causal factor of human nasopharyngeal carcinoma (NPC). High levels ‍of serum IgA and IgG antibodies to EBV early and viral capsid antigens (IgA/EA, IgA/VCA, IgG/EA and IgG/VCA) ‍have been reported in NPC patients. Since specific serum IgA/EA, IgA/VCA and IgG/EA are claimed to be useful ‍serological markers for NPC. In order to evaluate whether plasma IgA/EA, IgA/VCA, IgG/EA and IgG/VCA antibody ‍levels are useful markers for diagnosis and prognosis of Thai NPC, we examined the prevalence of these antibodies ‍in 79 NPC patients, and 127 age-matched controls (47 healthy subjects (HS), 32 cases of other disease (OD) and 48 ‍cases of other cancer (OC)) by using an indirect immunofluorescence assay. The prevalence of plasma IgA/EA, IgA/ ‍VCA, and IgG/EA in NPC patients (55.7, 68.4 and 68.4%) was significantly higher than in the HS (0.0, 0.0 and ‍20.5%,), OD (0.0, 0.0 and 3.1%) and OC (0.0, 0.0 and 20.8%) groups (p<0.05). The prevalence of plasma IgG/VCA ‍in NPC patients (93.7%) was significantly different from those for the OD and OC groups (71.9 and 43.8%) but not ‍for the HS group (89.4%). In NPC patients, the geometric mean titers (GMT) of plasma IgA/EA, IgA/VCA and IgG/ ‍EA were increased with an advanced clinical stage of disease but not IgG/VCA. In contrast, GMT of IgG/VCA was ‍increased with aggressive type of disease (histological type) but not IgA/EA, IgA/VCA, and IgG/VCA. The results of ‍our study suggest that plasma IgA/EA, IgA/VCA and IgG/EA antibodies may be useful markers for diagnosis and ‍assessing prognosis of Thai NPC. ‍     

Subtype distribution and long-term titer fluctuation patterns of serum anti-Epstein-Barr virus antibodies in a non-nasopharyngeal carcinoma population from an endemic area in South China：a cohort study

Background: Serum immunoglobulin A antibodies against Epstein–Barr virus (EBV), viral capsid antigen (VCA?IgA) and early antigen (EA?IgA), are used to screen for nasopharyngeal carcinoma (NPC) in endemic areas. However, their routine use has been questioned because of a lack of specificity. This study aimed to determine the distributions of different subtypes of antibody and to illustrate how the natural variation patterns affect the specificity of screening in non?NPC participants. Methods: The distribution of baseline VCA?IgA was analyzed between sexes and across 10?year age groups in 18,286 non?NPC participants using Chi square tests. Fluctuations in the VCA?IgA level were assessed in 1056 non?NPC participants with at least two retests in the first 5?year period (1987–1992) after the initial screening using the Kaplan–Meier method. Results: The titers of VCA?IgA increased with age (P < 0.001). Using a previous serological definition of high NPC risk, nasopharyngeal endoscopy and/or nasopharyngeal biopsy would be recommended in 55.5% of the non?NPC partici?pants with an initial VCA?IgA?positive status and in 20.6% with an initial negative status during the 5?year follow?up. However, seroconversions were common; 85.2% of the participants with a VCA?IgA?positive status at baseline con?verted to negative, and all VCA?IgA?negative participants changed to positive at least once during the 5?year follow?up. The EA?IgA status had a high seroconversion probability (100%) from positive to negative; however, it had a low probability (19.6%) from negative to positive. Conclusions: Age? and sex?specific cutoff titer values for serum anti?EBV antibodies as well as their specific titer fluc?tuation patterns should be considered when defining high NPC risk criteria for follow?up diagnostics and monitoring.     

Complementary serum test of antibodies to Epstein-Barr virus nuclear antigen-1 and early antigen: a possible alternative for primary screening of nasopharyngeal carcinoma

This hospital-based cohort study evaluated the efficacy of three Epstein-Barr virus (EBV) - associated assays for nasopharyngeal carcinoma (NPC) primary screening and monitoring treatment outcome. Five hundred and seventeen consecutive subjects, including 156 NPC patients, 264 healthy volunteers and 97 patients with head and neck squamous cell carcinoma (HNSCC) were enrolled. The sensitivity and specificity of EBV IgAs to viral capsid antigen (VCA), complementary EBV IgAs to early antigen and nuclear antigen-1 (EA+EBNA-1), and EBV DNA load were examined by immunofluorescent assays, enzyme-linked immunosorbent assays, and quantitative real-time PCR, respectively. After constructing the receiver operating characteristics to demonstrate screening efficacy, EBV EA+EBNA-1 IgA (AUC: 0.952; 95% CI, 0.930-0.974) was proved superior to EBV VCA IgA (AUC: 0.888; 95% CI, 0.854-0.922) or EBV DNA load (AUC: 0.893; 95% CI, 0.854-0.932) in differentiating NPC patients from controls. Comparison of screening efficacy between NPC patients and HNSCC patients revealed EBV EA+EBNA-1 IgA (AUC: 0.964; 95% CI, 0.943-0.985) still outperformed EBV VCA IgA (AUC: 0.884; 95% CI, 0.845-0.923). In subjects with higher serum titer or level equal to or above 1:80 and 6 EU/ml for EBV VCA IgA and EA+EBNA-1 IgA, the specificity reached as high as 99.2% and 95.1%, respectively, in the control groups. However, correlation of these three assays with clinicopathological manifestations of NPC, revealed only EBV DNA load significantly associated with N stage and overall stage in NPC patients. Additionally, EBV DNA load could be used to further raise the specificity of EBV EA+EBNA-1 IgA assays and was also the only assay to be consistently predictive of tumor relapse in post-treatment patients according to serial test results by time frame. Consequently, an EBV EA+EBNA-1 IgA-based protocol is recommended for mass screening, but EBV DNA load should be used solely for post-treatment monitoring for NPC in endemic areas.     

Serological mass survey for early detection of nasopharyngeal carcinoma in wuzhou city,china

A serological mass survey was carried out in Wuzhou City of the Guangxi Autonomous Region, China. Sera were collected from 12,932 persons between the ages of 40 and 59. The positive rate of VCA/IgA antibody-positive persons was 5.3%, but no EA/IgA antibody was found in sera from VCA/IgA-negative persons. Thirteen and nine nasopharyngeal carcinoma (NPC) patients were detected from the VCA/IgA and EA/IgA antibody-positive persons, respectively. With the present combination method the detection rate of NPC for 12,932 persons was 100.5/100,000 and for 680 VCA/IgA antibody-positive persons it was 1,900/100,000. Thus, the rate was twice and 37 times higher, respectively, than the annual incidence rate of NPC in persons of the same age group from 1975-1978 in Wuzhou City. Of 13 NPC patients, 9 were in stage 1(70%) and 4 in stage II (30%). Therefore, it is possible to reduce the mortality rate of NPC in Wuzhou City by radiotherapy of NPC patients in the early stage of the disease. The present results further suggest that EB virus is closely associated with NPC.     

EB病毒抗体检测在不同年龄壮族鼻咽癌患者中的应用

目的探讨桂西地区壮族鼻咽癌患者EB病毒各年龄段Rta/IgG、VCA/IgA、VCA/IgG及Zta/IgG抗体的rA值和阳性率与年龄的关系。方法收集140 例未经治疗的鼻咽癌患者和280例健康人的血清,用酶联免疫吸附法（ELISA）检测Rta/IgG、VCA/IgA、VCA/IgG及Zta/IgG抗体,分别计算各年龄段的抗体水平及阳性率并进行统计学分析。结果鼻咽癌患者各年龄段VCA/IgA抗体rA值和阳性率差异均有统计学意义 (P<0.05)。在50岁以后年龄段的患者与健康人Rta/IgG、VCA/IgA抗体阳性率比较差异有统计学意义 (P<0.05)。在50岁以后的年龄段患者与健康人Zta/IgG抗体阳性率比较差异无统计学意义 (P>0.05)。结论壮族鼻咽癌患者与健康人EB病毒Rta/IgG、VCA/IgA及Zta/IgG抗体水平和阳性率比较存在年龄上的差异。在鼻咽癌的临床诊断和高危人群筛查中有必要根据不同年龄段的人群界定不同的阳性临界值。     

抽吸性血痰患者的临床与实验室检查对鼻咽癌的鉴别诊断意义

目的:探讨抽吸性血痰患者 的临床与实验室检查结果对鼻咽癌 与非癌疾病的鉴别诊断意义。方法 将102例以抽吸性血痰为主诉的患 者,按最终诊断分为两组(鼻咽癌组 与非癌组),对其临床与实验室检查 资料进行回顾性分析、对比。结果 72例鼻咽癌患者的男女性别比为 2.79;中位年龄为43.6岁;血清E 病毒VCA/IgA抗体阳性率为 94.44%,阳性者中高滴度者占 70.59%;EA/IgA抗体阳性率 30.56%。30例非癌患者的性别比为 1.00;中位年龄39.24岁;血清E 病毒VCA/IgA抗体阳性率30.00% 阳性者中高滴度者占11.12%;没发 现EA/IgA抗体阳性者。结论:抽吸 性血痰患者的性别、年龄、病程和 EBV抗体水平等因素综合分析,有助 于鼻咽癌与非癌患者的鉴别诊断。     

血浆 EB病毒游离 DNA检测对监测鼻咽癌患者预后的意义

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 40 Gy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 135 100 copies/ml(四分线区域 5 525～ 1 003 750 copies/ml) >局部复发组的 20 500(四分线区域 0～ 58 500 copies/ml) > 无瘤生存组的 0 copy/ml(四分线区域 0～ 0 copy/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 1 000 000 copies/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 40 Gy时及放疗结束时, EBV-DNA水平逐渐降低,平均含量分别为 32 050 copies/ml(四分线区域 3 880～ 317 750 copies/ml)、 0 copy/ml(四分线区域 0～ 14 375 copies/ml)、 0 copy/ml(四分线区域 0～ 2 940 copies/ml), P均 < 0.05, 而 VCA/IgA、 EA/IgA的水平未见明显变化. 结论: 血浆 EBV-DNA检测可用于监测鼻咽癌患者预后,其价值明显优于 VCA/IgA、 EA/IgA.     

The reliability of IgA antibody to Epstein-Barr virus (EBV) capsid antigen as a test for the diagnosis of nasopharyngeal carcinoma (NPC)

Since patients with nasopharyngeal carcinoma were first reported to have elevated levels of IgA antibody to Epstein-Barr virus (EBV) in their sera, workers in a number of countries have studied the possibility that this assay could be used in the diagnosis and monitoring of patients with this disease. In the United States, a collaborative project involving seven centers has been established to investigate the potential value of IgA antibody to EBV viral capsid antigen (VCA) as a clinical tool. In this report, we will summarize the results obtained from three studies: a comparison of EBV serology in three laboratories; a retrospective study of 37 nasopharyngeal carcinoma (NPC) patients and controls, and a prospective study of 126 NPC patients and 683 controls, including 149 patients with other malignancies involving the head and neck. The study of testing comparability in three laboratories demonstrated the feasibility of using this assay in a number of laboratories. The retrospective study confirmed the difference in IgA antibody titers between NPC patients and matched controls. The prospective study showed a relationship between IgA antibody titers and histopathology but not disease stage. IgA antibody titers were elevated more frequently in patients with nonkeratinizing or poorly differentiated types of NPC than for the well-differentiated squamous cell carcinomas. While IgA antibodies to EBV VCA appear to be of value in the early detection and diagnosis of NPC, it is possible that additional serologic tests for immunity to EBV, such as IgG antibody to VCA or early antigen (EA), will improve even further the clinical value of EBV serology in the management of NPC.