鼻咽癌患者血浆EBVDNA水平和VCA—IgA检测的临床意义

目的：探讨鼻咽癌患者血浆EBVDNA水平和VCA—IgA联合检测对鼻咽癌早期诊断的临床价值。方法：用荧光定量PCR方法检测血浆EBVDNA水平，常规免疫酶法检测VCA—IgA抗体滴度。结果：68例鼻咽癌患者中，EBVDNA阳性率95．59％，中位拷贝数93× 10^4 copies／ml，VCA—IgA抗体阳性率92．65％，抗体滴度≥1：20；其他头颈肿瘤36例中，EBVDVA阳性率5．56％，中位拷贝数为0copies／ml，VCA—IgA抗体阳率36．11％，阳性滴度均≤1：20；健康对照组EBVDNA阳性率为35．56％，其滴度除3例≥1：40外，余均≤1：20。鼻咽癌患者中EBVDNA和VCA—IgA抗体阳性率显著高于对照组。结论：进-步证实EBV与鼻咽癌有密切关系；EBVDNA水平和VCA—IgA抗体滴度联合检测，有助于鼻咽癌的早期辅助诊断。     

EB病毒IgG-EA抗体测定在鼻咽癌筛查中的意义

目的：探讨EB病毒早期抗原（EA）IgG抗体测定在鼻咽癌筛查中的价值。材料和方法：依序列测定方法,用免疫酶染色法对从6257份血清筛查后获得的,IgA／VCA滴度≥1：80的158例血清再进行EBVIgG／EA酶联免疫吸附法（ELISA）测定和IgA／EA抗体免疫酶染色法测定。同时对上述158例血清阳性者进行鼻咽光纤镜和病理检查。根据检查结果比较单项阳性与双项检查阳性血清间鼻咽癌的检出率（阳性预示值）。结果：在这158例阳性血清者中检出鼻咽癌12例。三组阳性血清诊断鼻咽癌的预示值分别是,第一组（IgA／VCA≥1：80）为7．6％（12／158）,第2组（IgA／VCZ≥1：80＋IgA／EA≥1：5）为18．2％（8／44）,第3组（lgA／VCA≥1：8和lgG／EAOD值≥0．18）为15．9％（11／69）。第一组的阳性预示值最低（P＜0．05）,其余两组间无差异P＞005）。第3组检出的11例鼻咽癌包括了第2组中所有的8例鼻咽癌和另外3例IgA／EA阴性鼻咽癌。结论：从序列测定获得的双项阳性血清中筛查到的鼻咽癌比率高于单项lgA／VCA阳性血清。用IgG／EA与IgA／VCA组合测定的双项阳性血清比用IgA／EA与IgA／VCA组合测定的双项阳性血清能查出更多的鼻咽癌,因此该组合更适合于鼻咽癌筛查。     

有鼻咽癌家族史个体血清EB病毒EBNA EBZta抗体水平分析

目的：通过对有鼻咽癌家族史个体血清中EB病毒EBNA、EBZta抗体水平的分析，了解该人群患鼻咽癌的风险情况.方法：选择鼻咽癌患者41例，有鼻咽癌家族史的非患者43例，正常人群90例，用ELISA检测血清EBZta IgG和EBNA1 IgA抗体；结果：有鼻咽癌家族史个体的EBZta IgG和EBNA1 IgA两抗体水平与正常人群对照组比较没有显著差异（t=1．085，t=0．014，P〉0．05），与鼻咽癌患者比较显示低于鼻咽癌患者组（t=9．789和t=8．836，P〈0．001）；以rOD值高于阳性临界值为阳性，有鼻咽癌家族史个体血清EBZta IgG阳性比例高于正常人对照组（Х^2=11．34，P〈0．01）.而EBNA1 IgA阳性比例两人群比较没有显著性差异（Х^2=1．304，P〉0．05）。结论：有鼻咽癌家族史个体其EB病毒被再激活的频率增高，反映该人群患鼻咽癌的危险性比正常人群要高。     

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），对其临床与实验室捡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EB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EB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。     

鼻咽癌患者的EB病毒IgM／VCA抗体反应的研究

本文应用免疫酶法检测了162例鼻咽癌、34例鼻咽癌粘膜病变、41例其他肿瘤和80例正常人(其中35例已知IgA/VCA抗体阳性)血清中IgM/VCA抗体,并与IgA/VCA和IgA/EA抗体进行比较。发现鼻咽癌患者血清中不仅含有高滴度的IgA/VCA抗体,而且含有高滴度的IgM/VCA抗体,阳性率(≥1:10)分别为97.53％和93.20％,GMT为157.60和95.75。两种抗体水平均明显高于其他对照组。有临床分期的62例鼻咽癌患者的IgM抗体水平,有随病程进展而略有升高的趋势。提示鼻咽癌患者体内的EB病毒慢性持续感染和活跃的复制。 鼻咽癌患者与IgA/VCA阳性的正常人血清中IgA/VCA和IgM/VCA抗体双阳性率分别为92.0％和31.43％;IgA/VCA和IgA/EA抗体双阳性率为48.76％和14.29％。鼻咽癌患者血清中,前者双阳性率高于后者双阳性率,且与正常相比有显著差异(P<0.01)。表明IgA/VCA和IgM/VCA抗体一起作为早期发现鼻咽癌的血清学指标,可能优于沿用的IgA/VCA和IgA/EA指标,操作和成本亦较方便和便宜。     

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。     

治疗前血中性粒细胞数目和白蛋白水平预测鼻咽癌预后的临床意义

  目的  研究治疗前中性粒细胞、淋巴细胞、单核细胞及白蛋白水平与鼻咽癌患者预后的相关性。  方法  选取401例在中山大学肿瘤医院进行初次诊断的鼻咽癌患者。记录患者免疫相关参数值及白蛋白水平。Kaplan-Meier和Log-rank分析比较总生存期和无进展生存期。采用Cox回归风险模型来确定预后因素。  结果  治疗前高中性粒细胞>5.20×109/L（n=172）患者在总生存期和无进展生存期上均小于治疗前低中性粒细胞≤5.20×109/L（n=229）患者（P=0.014,P=0.009）。治疗前高白蛋白水平组>43.00 g/L（n=253）在总生存期和无进展生存期均高于治疗前低白蛋白组≤43.00 g/L（n=148）（P < 0.001,P=0.006）。多因素分析发现治疗前中性粒细胞数目是鼻咽癌患者无进展生存期的独立预后因素,治疗前白蛋白水平是鼻咽癌患者总生存期的独立预后因素。  结论  治疗前外周血中性粒细胞数目与白蛋白水平可作为鼻咽癌患者生存的独立预后因素。      

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。     

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。     

鼻咽癌高发区居民EB病毒感染流行病学研究

分析广东省鼻咽癌高发区30~59岁16 355人EB病毒EBNA1/IgA和VCA/IgA抗体在不同性别、年龄人群中的分布及患鼻咽癌概率情况。方法:应用ELISA法检测EBNA1/IgA和VCA/IgA抗体,计算抗体阳性率和鼻咽癌风险概率,从不同层面分析血清EB病毒抗体特征。结果:人群EBNA1/IgA阳性率为4.04%,男、女分别为5.11%和3.23%,除30～39岁年龄段以外,EBNA1/IgA阳性率均显示男性高于女性（P<0.05）。人群VCA/IgA阳性率为5.84%,男女性分别为5.97%和5.74%,35～59岁年龄段VCA/IgA阳性率表现与性别无关（P>0.05）。男性EBNA1/IgA和VCA/IgA阳性率与年龄呈正相关（P<0.05）,各年龄段抗体阳性率分布与鼻咽癌发病年龄趋势基本吻合,尤其是EBNA1/IgA与年龄显示了较好的一致性。女性中以上指标未见随年龄增长而上升。结论:鼻咽癌高发区人群EBNA1/IgA抗体分布存在性别上的差异。男性人群的EBNA1/IgA和VCA/IgA阳性率随着年龄增长逐渐上升,女性以上指标与年龄无显著相关。EBNA1/IgA抗体阳性率高峰年龄段与鼻咽癌高发年龄段具有较好的一致性,有望成为鼻咽癌筛查的理想指标。      

Prognostic significance of SOX2 expression in nasopharyngeal carcinoma

The significance of SOX2 in nasopharyngeal carcinoma (NPC), a tumor associated with Epstein-Barr virus (EBV), remains unclear. Here, we reported that, in the univariate analysis, SOX2 expression was correlated with a poorer distant metastasis-free survival (DMFS). The EBV-VCA/IgA titers in patients with NPC were also associated with a poorer overall survival (OS). Patients with NPC, who had both strong staining of SOX2 and high titers of EBV-VCA/IgA, had the poorest prognoses. Therefore, SOX2 or the combination of the SOX2 expression level and EBV-VCA/IgA titers could be valuable to predict distant metastasis or the prognosis of NPC.     

Prognostic value of serum Epstein–Barr virus antibodies in patients with nasopharyngeal carcinoma and undetectable pretreatment Epstein–Barr virus DNA

Epstein–Barr virus (EBV) is closely associated with nasopharyngeal carcinoma (NPC). Serum IgA antibodies against early antigen (EA‐IgA) and viral capsid antigen (VCA‐IgA) are the most commonly used to screen for NPC in endemic areas. However, the prognostic value of serum EA‐IgA and VCA‐IgA in patients with NPC is less clear. We hypothesize that serum EA‐IgA and VCA‐IgA levels have prognostic impact for survival outcomes in NPC patients with undetectable pretreatment EBV (pEBV) DNA. In this series, 334 patients with non‐metastatic NPC and undetectable pEBV DNA were included. Serum EA‐IgA and VCA‐IgA were determined by ELISA. After analysis, serum EA‐IgA and VCA‐IgA loads correlated positively with T, N, and overall stage (all P < 0.05). Serum EA‐IgA was not associated with survival outcome in univariable analyses. But patients with serum VCA‐IgA >1:120 had significantly inferior 5‐year progression‐free survival (80.4% vs 89.6%, P = 0.025), distant metastasis‐free survival (88.4% vs 94.8%, P = 0.050), and locoregional relapse‐free survival (88.4% vs 95.6%, P = 0.023; log–rank test). Multivariable analyses revealed that N stage was the only independent prognostic factor (all P < 0.05), but the VCA‐IgA became insignificant. Further analyses revealed that serum VCA‐IgA was not an independent prognostic factor in early N (N0–1) or advanced N (N2–3) stage NPC. In summary, although both EA‐IgA and VCA‐IgA correlate strongly with TNM stage, our analyses do not suggest that these antibodies are prognostic biomarkers in patients with NPC and undetectable pEBV DNA.     

Comparison of plasma Epstein-Barr virus (EBV) DNA levels and serum EBV immunoglobulin A/virus capsid antigen antibody titers in patients with nasopharyngeal carcinoma

BACKGROUND: Serologic measurement of antibodies to Epstein-Barr virus (EBV) immunoglobulin A/viral capsid antigen (IgA/VCA) and early antigen (IgA/EA) has been used widely to screen for nasopharyngeal carcinoma (NPC) in China. Recently, it was found that plasma EBV DNA concentration is an indicator for the staging and prognosis of patients with NPC. To determine whether there is a correlation between plasma EBV DNA levels and serum levels of IgA/VCA, the authors measured both in patients with NPC and in a control group. METHODS: Real-time polymerase chain reaction was used for quantitative analysis of plasma EBV DNA concentration, and enzyme-linked immunoadsorbent assay was used to measure EBV VCA/IgA in patients with primary NPC (n = 120 patients), locally recurrent NPC (n = 8 patients), and distant metastatic NPC (n = 21 patients) among 76 patients with NPC after the completion of radiotherapy, in 60 patients with NPC in clinical remission, in 38 patients with non-NPC tumors, and in 47 control individuals. RESULTS: The median plasma EBV DNA levels were 6200 copies/mL, 9200 copies/mL, and 2050 copies/mL in patients with primary, locally recurrent, and distant metastatic NPC, respectively, but declined to 0 copies/mL in patients with clinically remissive NPC, in patients who completed radiotherapy, in patients with non-NPC tumors, and in the control group. In contrast, EBV VCA/IgA titers and detection rates remained high in all NPC groups. Plasma EBV DNA levels were significantly higher in patients who had serum VCA/IgA titers > or = 1:640 (median, 83,450 copies/mL) compared with the levels in patients who had titers < or = 1:320 (median, 17,200 copies/mL). Patients with NPC who had advanced TNM stage (Stages III and IV; median, 8530 copies/mL) and T classification (T3 and T4 tumors; median, 8530 copies/mL) had significantly higher plasma EBV DNA levels compared with patients who had early TNM stage (Stages I and II; median, 930 copies/mL) and T classification (T1 and T2 tumors; median, 3700 copies). Patients who had advanced TNM stage NPC had significantly higher mean VCA/IgA titers (1:424) compared with patients who had early TNM stage NPC (1:246), but there was no correlation between IgA/VCA titer and T or N classification of NPC. CONCLUSIONS: The results suggest that plasma EBV DNA detection is a more sensitive and specific marker than the serum IgA/VCA titer for the diagnosis and monitoring of patients with NPC. These findings provide convincing evidence for the use of plasma EBV DNA measurements for the early diagnosis and staging of NPC as well as for monitoring recurrence and metastasis of this tumor.     

Diagnostic value of serum EBV-DNA quantification and antibody to viral capsid antigen in nasopharyngeal carcinoma patients

We compared the amount of serum Epstein-Barr virus DNA (EBV-DNA) detected in patients with nasopharyngeal carcinoma (NPC) in a high-incidence area, represented by Taiwan, and a low-incidence area, represented by Japan, using real-time quantitative PCR. The median serum EBV-DNA value in 41 Japanese NPC cases was 5450 copies/ml, and that in in 23 Taiwanese cases was 2125 copies/ml. The median serum EBV-DNA value in all 64 NPC cases was significantly higher than in control groups. Using receiver-operating-characteristic (ROC) curves, the sensitivity and specificity of EBV-DNA quantification were determined (cut-off point, 6.87 copies/ml; sensitivity, 0.855; specificity, 0.885) and compared with those of EBV-viral-capsid-antigen (VCA) titers; the results showed that EBV-DNA was a more sensitive and specific parameter than EBV-VCA titer. Then, we analyzed 19 NPC patients in whom recurrence developed (11 Japanese and 8 Taiwanese), and 26 NPC patients in continuous remission. Although there was no significant difference in EBV-DNA values between Japanese and Taiwanese patients, the value was significantly higher in the 19 patients with recurrence than in those in remission. ROC analysis again revealed a higher diagnostic value of EBV-DNA than EBV-VCA. These results suggest EBV-DNA is a more reliable tumor marker than EBV-VCA in both high-incidence and low-incidence areas of NPC.     

A comparison of EBV serology and serum cell-free DNA as screening tools for nasopharyngeal cancer: Results of the Singapore NPC screening cohort

We aimed to evaluate the effectiveness of nasopharyngeal cancer (NPC) screening by comprehensive clinical follow-up and adjunctive Epstein–Barr virus (EBV) testing. In a prospective cohort study, 524 individuals with a first-degree family history of NPC were recruited at a university clinical center in Singapore. The cohort was evaluated at baseline and at 6 monthly intervals, with a complete head and neck examination including nasopharyngeal endoscopy. Blood was taken at baseline and at yearly intervals for EBV Viral Capsid Antigen (VCA) IgA, EBV Early Antigen (EA) IgA serology and serum cell-free EBV DNA. Nasopharyngeal biopsy was performed when any irregularity in the nasopharynx was observed, or when EBV markers were elevated. The mean duration of follow-up was 57.7 months, with an average of 8.6 clinical visits per participant. Five participants (0.96%) were identified to have NPC, giving a prevalence of 199 per 100,000 person-years of screening. Four of the five NPC cases identified had asymptomatic T1 disease, at an earlier stage compared to NPC patients diagnosed in the clinic during the same time period (p = 0.0297). All NPC cases identified had elevated EBV-EA IgA titers ≥1:10, with a specificity of 94.6% and a positive predictive value of 15.2%, outperforming EBV-VCA IgA and serum EBV DNA. Two NPC cases were biopsied only because of elevated EBV serology titers, with increasing EBV-EA IgA titers preceding the diagnosis of NPC. In conclusion, screening for NPC is effective in identifying early-stage disease. Adjunctive EBV-EA IgA testing improved the effectiveness of screening.     

临床颈部淋巴结阴性鼻咽癌患者放射治疗预后因素分析

目的：分析临床N0期鼻咽癌患者临床资料及生存情况,并探讨其预后因素。方法：回顾性分析1989—05—01—2009—12—31汕头大学医学院附属肿瘤医院放疗科627例临床颈部淋巴结阴性（N。期）鼻咽癌患者的临床资料。所有患者治疗前均行颅底鼻咽部CT扫描。采用60Co7线或直线加速器6MVX射线进行治疗,常规分割,连续放疗。采用面颈联合野照射DT36-40Gy,然后改用双耳前野加双上颈切线野照射。生存率分析采用Kaplan-Meier方法,Log—rank法检验差异性,Cox风险比例模型进行多因素分析。结果：627例临床颈部淋巴结阴性鼻咽癌患者5年总生存率为78．6％,无病生存率为68．9％,疾病相关生存率为79．9％,局部无失败生存率为81．4％,区域无失败生存率为95．9％,局部区域无失败生存率为78．5％,无远处转移生存率为88．4％;10年总生存率为66．6％,无病生存率为55．9％,疾病相关生存率为70．3％,局部无失败生存率为72．8％,区域无失败生存率为91.9％,局部区域无失败生存率为68．8％,无远处转移生存率为85．2％。作为首次治疗的首发失败事件,单纯局部失败率为16．6％（104／627）,区域淋巴结失败率为2．4％（15／627）,远处转移率为8．6％（54／627）。多因素分析结果显示,T分期是影响No期鼻咽癌患者总生存的独立因素。男性、T晚期和贫血者无病生存率较低。结论：N0期鼻咽癌患者有较好的预后,局部失败是治疗失败的首要原因,T分期是影响总生存率的预后独立因素,男性、T分期和贫血是影响无病生存率的独立预后因素。     

血清胱抑素C在多发性骨髓瘤预后中的意义

目的 探讨血清胱抑素C（Cys-C）在多发性骨髓瘤（MM）预后中的意义.方法 收集初诊MM患者160例,平均年龄61.38岁,治疗前检测Cys-C、血清肌酐、β2-微球蛋白（β2-MG）、乳酸脱氢酶（LDH）及血红蛋白水平;中位随访38个月,观察Cys-C与总生存（OS）、无事件生存（EFS）的关系.结果 160例MM患者Cys-C水平为（0.96±0.32） mg/L,高于80例健康对照组的（0.71±0.16）mg/L（P＜0.000）;按ISS分期,Ⅰ期患者Cys-C水平为（0.70±0.13）mg/L,Ⅱ期为（0.87±0.16）mg/L,Ⅲ期为（1.23±0.33）mg/L,各期间Cys-C水平差异均有统计学意义（均P＜0.05）;Cys-C与血清肌酐、β2-MG、LDH呈正相关（r=0.669,r=0.672,r=0.521;均P＜ 0.000）,与血红蛋白呈负相关（r=-0.436,P＜ 0.000）.用ROC分析,Cys-C水平＞0.95 mg/L的患者和Cys-C≤0.95 mg/L的患者相比有较短的EFS和OS（中位EFS分别为30、57个月,P＜0.05;中位OS分别为43、68个月,P＜0.05）.结论 对于MM患者,Cys-C不仅是反应肾损害的敏感指标,也是反应肿瘤负荷及判断预后的指标之一.     

鼻咽癌患者血清MTA1浓度与临床特征及预后的关系

目的:本研究旨在检测鼻咽癌患者治疗前血清中MTA1的水平，探讨其与临床特征及预后的关系。方法:收集2011年3月至2015年4月在我院治疗的初诊无转移鼻咽癌患者96例的临床资料及治疗前血清标本。利用ELISA方法测定血清MTA1浓度，以中位浓度为截断值，将患者分为低表达组和高表达组，采用单因素和多因素方法分析治疗前患者血清中MTA1浓度与临床病理特征及生存率的关系。结果:全组患者血清MTA1中位浓度为112 pg/ml（0~8 215 pg/ml），中位随访47个月，23例患者发生远处转移，治疗前MTA1水平与远处转移相关（P=0.031），但与性别、年龄、T、N分期及临床分期均无关。生存率分析显示，MTA1高表达组4年DMFS为73.2%，显著低于MTA1低表达组的86.7%（P=0.039）；MTA1高表达组与低表达组患者4年PFS分别为 70.8%和87.3%，趋向于有统计学意义（P=0.054）；尽管MTA1高表达患者4年OS低于MTA1低表达患者，但差异无显著统计学意义（82.1% vs 86.9%,P=0.091）。多因素分析表明:治疗前患者血清MTA1表达水平并不是鼻咽癌患者OS、PFS及DMFS的独立预后因素（P=0.349、P=0.126、P=0.106）。结论:鼻咽癌患者治疗前血清MTA1高表达与无转移生存相关。     

唾液中EB病毒抗体检出用于早诊鼻咽癌的研究

目的：建立在唾液标本中检出 EB病毒 IgA抗体的方法,以快速、特异诊断鼻咽癌。方法：人工合成 EBV-DNA酶及 EA-D多肽片段,分别作为捕捉抗原,采用 ELISA法检测鼻咽癌患者和健康人血清及唾液中 IgA/ EBV-DNA酶和 EA-D抗体。结果：通过检出 O.D值,经统计学处理,选出鼻咽癌诊断阈值为：血清 O.D值≥ 0.3,唾液 O.D值≥ 0.45（ DNA酶与 EA-D两者阈值一致）。鼻咽癌与健康者两组间 DNA酶与 EA-D的 IgA滴度均为 P< 0.0001,有非常显著性差异,与病理确诊相比,阳性符合率为 72.6％～ 77.3％。结论：证实 EBV合成肽链作为捕捉抗原,唾液为标本,用 ELISA法是可行的,方法简便,重复性好,价廉,但诊断符合率需进一步提高。     

Ⅱ期鼻咽癌同步放化疗与单纯放疗的疗效

目的 比较Ⅱ期鼻咽癌同步放化疗与单纯放疗的疗效。 方法 收集2007年6月至2014年4月在我院接受同步放化疗的Ⅱ期鼻咽癌患者56例为同步组,同期行单纯放疗的Ⅱ期鼻咽癌患者51例为单放组。对两组患者生存状况进行回顾性分析,比较两组总生存率、无远处转移生存率、无局部区域复发生存率及无失败生存率。 结果 同步组与单放组相比,各种生存率差异均无统计学意义（P均＞0.05）,两组总生存率、无远处转移生存率、无局部区域复发生存率及无失败生存率的风险比（HR）分别为1.15 （95%CI＝0.21~6.36）、1.10 （95%CI＝0.26~4.73）、1.16 （95%CI＝0.33~6.89）、1.38 （95%CI＝0.36~5.25）。多因素分析提示年龄是无局部区域复发生存率的预后因素（P=0.030）,年龄越大生存率越低。 结论 与单纯放疗相比,同步放化疗未能改善Ⅱ期鼻咽癌患者的预后,调强放疗联合同步化疗对Ⅱ期鼻咽癌预后的影响还需进一步研究。