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目的探讨鼻咽癌复发患者治疗前后EB病毒(EBV)-DNA、病毒衣壳蛋白抗原-IgA(VCA-IgA)和早期抗原-IgA(EA-IgA)的表达情况及其临床意义。方法选择鼻咽癌复发患者124例为复发组,其中手术组77例,采用鼻内镜手术或鼻内镜手术联合放、化疗;放化疗组47例,采用放疗和(或)化疗。另选取30例鼻咽癌治疗后放射性颅底骨坏死患者(无复发)为对照组。在治疗前及治疗结束时,检测所有患者血清VCA-IgA、EA-IgA、EBV-DNA阳性表达情况。结果治疗前,复发组、对照组EBV-DNA阳性率分别为51.61%、0,两组VCA-IgA和EA-IgA阳性率比较,差异均无统计学意义(P>0.05)。治疗前,局部、颈部、局部及颈部复发的鼻咽癌患者间EBV-DNA、VCA-IgA和EA-IgA阳性率比较,差异无统计学意义(P>0.05)。在Ⅰ期、Ⅱ期、Ⅲ期及Ⅳ期复发鼻咽癌患者中,EBV-DNA阳性率随临床分期增高而增高(P<0.05),但VCA-IgA及EA-IgA阳性率比较差异无统计学意义(P>0.05)。治疗前,手术组与放化疗组EBV-DNA、VCA-IgA、EA-IgA阳性率比较,差异均无统计学意义(P>0.05);治疗后,手术组EBV-DNA转阴率高于放化疗组(P<0.05),且手术组EBV-DNA阳性率低于放化疗组(P<0.05),但两组VCA-IgA及EA-IgA阳性率比较,差异无统计学意义(P>0.05)。结论检测EBV-DNA可能有助于判断鼻咽癌复发和分期,手术治疗有助于清除机体的EBV。但在鼻咽癌治疗后放射性颅底骨坏死患者中仍可检出VCA-IgA、EA-IgA,建议对患者的抗体水平进行动态观察。
Objective To investigate the expression of Epstein-Barr virus (EBV) -DNA, viral capsid antigen-IgA (VCA-IgA) and early antigen-IgA (EA-IgA) in patients with recurrent nasopharyngeal carcinoma before and after treatment and their clinical significance. Methods A total of 124 patients with recurrent nasopharyngeal carcinoma (NPC) were selected as the recurrent group. Among them, 77 patients in the operation group received endoscopic or endoscopic surgery combined with radiotherapy and / or chemotherapy. Radiotherapy and / or chemotherapy were used in 47 patients in the radiotherapy and chemotherapy group. Another 30 cases of nasopharyngeal carcinoma after radioactive skull necrosis patients (no recurrence) as the control group. Serum VCA-IgA, EA-IgA and EBV-DNA were detected in all patients before and at the end of treatment. Results Before treatment, the positive rates of EBV-DNA in recurrence group and control group were 51.61%, 0 respectively. There was no significant difference in the positive rates of VCA-IgA and EA-IgA between the two groups (P> 0.05). The positive rate of EBV-DNA, VCA-IgA and EA-IgA in nasopharyngeal carcinoma patients with local, neck, local and neck recurrence before treatment was no significant difference (P> 0.05). The positive rates of EBV-DNA in stage I, II, III and IV recurrent NPC patients increased with clinical stage (P <0.05), but the positive rates of VCA-IgA and EA-IgA were not statistically different Significance (P> 0.05). The positive rates of EBV-DNA, VCA-IgA and EA-IgA in the operation group and the radiotherapy and chemotherapy group were not significantly different before treatment (P> 0.05). After treatment, the EBV-DNA negative rate in the operation group was higher than that in the radiotherapy and chemotherapy group (P <0.05). The positive rate of EBV-DNA in operation group was lower than that in radiotherapy and chemotherapy group (P <0.05), but the positive rate of VCA-IgA and EA-IgA in the two groups had no significant difference ). Conclusion The detection of EBV-DNA may be helpful in judging the recurrence and staging of nasopharyngeal carcinoma. Surgical treatment may help to clear EBV. However, VCA-IgA and EA-IgA can still be detected in patients with radioactive skull base necrosis after nasopharyngeal carcinoma treatment, and it is suggested that the antibody level of the patients be dynamically observed.