广西苍梧县EB病毒1gA/VCA抗体阳性者的追踪观察

 本文报告对148029人进行了血清学普查中,除普查发现的55例鼻咽癌病人外,对lgA/VCA抗体阳性者进行了1—3年的追踪观察,又发现了32例新的鼻咽癌病人,总计87例,lgA/VCA抗体阳性者的鼻咽癌检出率为同年组人群的发病率的82倍,这些结果与梧州市的结果相似。从第一次采血lgA/VCA抗体阳性到临床确诊的时间为8～30个月,平均为13个月,即在鼻咽癌确诊前8—30个月已有lgA/VCA抗体存在,表明lgA/VCA抗体的存在与鼻咽癌的关系密切。同时表明对lgA/VCA抗体阳性者定期进行追踪观察对鼻咽癌的早期诊断是十分重要的。     

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.     

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…     

门诊433例EB病毒IgA／VCA抗体阳性者的EB病毒IgA／EA抗体测定

1989年1—6月我们用免疫酶法测定在我所就诊病人BE病毒IgA/VCA抗体,对433例抗体阳性者用免疫酶法测定EB病毒IgA/EA抗体.其结果报道如下: 材料和方法 1、来我所就诊病人采血免疫酶法测定血清中EB病毒IgA/VCA抗体,对抗体阳性者测定其IgA/EA抗体。 2、B_(95)—8细胞片本所自制。Raji细胞片由中国预防医学科学院病毒所肿瘤病毒室供给。     

鼻咽癌HSP70表达与血清EB病毒IgA/VCA的关系及其临床意义

背景与目的:热休克蛋白(HSP)70在许多恶性肿瘤中均有表达,但在鼻咽癌组织中的表达与血清IgA/VCA滴度及预后的关系尚不清楚。本研究旨在检测鼻咽癌组织中HSP70的表达和含量水平,探讨HSP70表达与鼻咽癌患者血清EB病毒IgA/VCA滴度及预后的关系。方法:采用SP免疫组化法检测38例鼻咽癌组织中HSP70表达,ELISA法检测38例鼻咽癌组织中HSP70含量,免疫酶标法检测38例鼻咽癌患者血清IgA/VCA滴度。结果:HSP70在38例鼻咽癌组织中表达率为60.5%。在不同性别、年龄、T分期、N分期和临床分期鼻咽癌组织中HSP70表达率均无显著性差异(P>0.05)。HSP70表达和含量与血清EB病毒抗体IgA/VCA滴度呈正相关(P=0.001)。HSP70阳性组和阴性组患者的5年生存率分别为65.2%和80.0%,5年无瘤生存率分别为40.0%和78.6%(P=0.04)。结论:HSP70在临床Ⅱ、Ⅲ期鼻咽癌患者癌组织中的表达与患者的IgA/VCA滴度正相关,HSP70阳性患者常规治疗后预后较差。     

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。     

鼻咽癌血清学检测中的复合阳性判断方法及其应用

EB病毒 (Epstein-Barr virus, EBV)与鼻咽癌的发生和发展密切相关 , 95% 以上的鼻咽癌血清都含有与 EB病毒壳抗原 (virus capscule antigen,VCA)相关的 IgA抗体 (IgA/VCA抗体 ). IgA/VCA(+ )人群被称为鼻咽癌的高危群体 [1]. 根据闵华庆等 [2]对 12万人的调查结果 , 在占总数 8.15% 的 IgA/VCA(+ )人群中 ,鼻咽癌的检出率比 IgA/VCA(- )人群高 40倍 . 尽管如此 , 在 IgA/VCA(+ )人群中鼻咽癌的阳性检出率仍然很低 , 只有 1.21% . 因此 , 有必要在 IgA /VCA(+ )人群中继续探索能提高鼻咽癌检出率和诊断准确性的方法 , 这也是关系到在鼻咽癌高发区如何提高血清学筛查效果的关键之一 . 1997年黄腾波等在广东四会鼻咽癌高发区对 IgA/VCA(+ )人群进行监测研究 , 提出了血清学与临床体检相结合的综合筛查方案 [3]. 当时检测 EBV早期复合抗原 (EBV-EA)相关 IgG抗体的酶联免疫吸附 (ELISA)法 (IgG/EA ELISA)尚未建立 . ELISA法与间接免疫酶染色 (IEA)检测 EBV-EA IgG抗体滴度的方法 (IgG/EA IEA)比较 , 在敏感性相同 (88.3% )的前提下 , 具有特异性 (98.3% )明显优于后者 (53.2% )的特点 [4] . 在特异性为 97.7% 的前提下 , 用 ELISA法检测鼻咽癌血清的敏感性 (89.2% )也显著高于用 IEA法测定 EBV-EA IgA抗体滴度 (IgA/EA IEA)的敏感性 (65.5% )[5].     

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。     

乳腺癌生物标志物表达状态的时间变异性

目的 探讨乳腺癌患者复发前后HER-2和激素受体表达是否存在时间变异性。方法 收集168例长期随访（>5年）的乳腺癌患者不同时间点的组织标本,并通过免疫组织化学进行HER-2、ER和PR检测,比较不同时间点上述生物标志的差异,同时分析与患者原始治疗和复发后治疗的关系。结果 168例乳腺癌患者中,36例复发,对其中27例复发组织标本进行检测。发现5例患者出现HER-2表达状态的变化,其中3例HER-2下调,2例上调;7例出现ER变化：5例ER表达下调,2例ER表达上调。2例出现PR下调。HER-2的表达变化与复发前放化疗无明显联系,但抗激素治疗导致HR表达下调,激素受体变化对随后的化疗治疗效果稍差（76% vs. 88%,P=0.21）,无疾病进展时间相似（33.4月vs. 38.60月,Log-rank=1.96,P=0.16）。结论 乳腺癌患者HER-2和激素受体的表达可以随时间变异,复发患者需要再次检测上述生物标志。     

Cutaneous CD56 positive natural killer and cytotoxic T-cell lymphomas

We report two cases of CD56 positive natural killer (NK) cell and cytotoxic T-cell cutaneous lymphomas and review the literature on these rare forms of non-Hodgkin's lymphoma. The first case was diagnosed to have extra nodal NK/T-cell lymphoma, nasal-type. She had a rapid downhill clinical course and died within 3 months of presentation. She had been started on systemic chemotherapy but did not respond. The second case was diagnosed as subcutaneous panniculitis-like T-cell lymphoma, CD56 positive variant. She presented with skin nodules that were quiescent for 10 years. Then the course of the disease suddenly changed and progressed rapidly. She had systemic chemotherapy and initially had a complete response, but she relapsed within 1 month of completion of chemotherapy. She then had partial response with further chemotherapy but relapsed rapidly. She died within 15 months of her lymphoma changing to its aggressive form. These cases illustrate the often poor prognosis of cutaneous CD56 positive lymphomas.     

鼻咽癌在不同高发区人群中的发病差异

目的：探索在广东省不同鼻咽癌高发区人群中发病差异，探讨相关病因发病因素。方法：１９８６～１９９５年对广东省四会市、广州市近６万人前瞻性研究，通过对两地人群鼻咽癌检出率，ＥＢＶＶＣＡ／ＩｇＡ阳性率，阳性人群癌前病变，癌变检出率，并以Ｌｏｇｉｓｔｉｃ多元回归分析其差异。结果：发现四会地区人群与广州地区人群相比：①高鼻咽癌检出率；②ＥＢＶＶＣＡ／ＩｇＡ阳性人群高合并鼻咽粘膜癌前病变；③ＥＢＶＶＣＡ／ＩｇＡ阳性人群高鼻咽癌检出率；④鼻咽粘膜癌前病变高癌变率。结论：ＥＢＶ感染与肿瘤遗传易感性在鼻咽癌发病上是否起着协同或加强作用值得进一步研究。     

Trends in the survival of patients with nasopharyngeal carcinoma between 1976 and 2005 in Sihui, China: a population-based study

Both the incidence a nd mortality of nasopharyngeal carcinoma(NPC) have decreased in Hong Kong and Taiwan but not in mainland China. The goal of this study was to analyze trends in NPC patient survival between 1976 and 2005 in Sihui, an area of mainland China with a population at high risk for NPC. A total of 1,761 patients diagnosed with NPC between 1976 and 2005 according to the records of Sihui Cancer Registry were followed to the end of 2006. We determined their observed and relative survival rates and used Cox proportional hazards regression analysis to predict prognosis. Our results showed that the 5-year and 10-year observed survival rates of NPC patients in Sihui were 50.5% and 36.9% , respectively, and the median survival time was 5.1 years. The 5-year observed survival rate of NPC patients diagnosed after 2000 was 69.8%, significantly higher than that of patients diagnosed between 1976 and 1985 (42.5% ; P0.001, relative risk=0.28). Similarly, the 5-year relative survival rate was 84.8% between 2000 and 2005 but 51.8% between 1976 and 1985. Besides date of diagnosis, other prognostic factors included patient sex and age and NPC clinical stage and histologic type. The relative risks of death from NPC were 0.76 [95% confidence interval (CI): 0.65-0.90] for female comparing to male and 1.28 (95% CI: 1.00-1.64) for WHO type I comparing to WHO types II and III. For the eldest age group and the latest clinical stage group, the relative risks were 2.22 (95% CI: 1.73-2.84) and 3.41 (95% CI: 2.34-4.49), respectively. Our results indicate that the survival of NPC patients in Sihui has significantly increased in recent years and this increase is not influenced by patient's sex, age, histologic type, and clinical stage. A reduction in mortality rate is expected in coming years.     

应用小地域分析模型研究四会市鼻咽癌的发病因素

目的：应用集合数据分析模型。在小地域水平，深层次上发现广东省四会市鼻咽癌发病和环境因素之间的关系及筛选发病因素。方法：利用该市1989-1998年资料，应用S-PLUS软件拟合集合数据分析模型。结果：共发现4个有统计学意义的因素，即成人食腌制品量，饮龙江水，烧香次数，习惯饮凉茶；其中四会市居民饮用水源的分布与鼻咽癌发病率分布基本一致，饮龙江水人群鼻咽癌发病率较高，饮其它水源人群鼻咽癌发病率较低，提示饮用龙江水可能与鼻咽癌的发病有关；集合数据分析模型的结果残差较小，稳健性好。结论：集合数据分析模型可用于小地域的各种群体水平的数据分析。及其它肿瘤等少见病的危险因素研究。     

Relevance of p53, bcl-2 and Rb expression on resistance to cisplatin-based chemotherapy in advanced non-small cell lung cancer

PURPOSE: Tumors with p53 overexpression have been associated with enhanced resistance to cisplatin-based chemotherapy in a few and small studies involving non-small cell lung cancer. The relationships and interactions between p53, Rb and bcl-2 immunostaining, clinical parameters and response to cisplatin-based chemotherapy were evaluated in the present study. EXPERIMENTAL DESIGN: Histological specimens obtained by bronchial or fine-needle biopsy from patients who underwent cisplatin-based chemotherapy between 1992 and 1999 were evaluated by immunostaining. RESULTS: There were 102 patients, 88 men. Median age was 63 years; 47 had stage III and 55 stage IV disease. Forty-six tumor samples (45%) had positive immunostaining for p53, 61 (59%) had negative immunostaining for Rb and 8 (8%) had positive immunostaining for bcl-2. The response rate of the group with p53 positive immunostaining was 26% versus 57% of the p53 negative group (P=0.004). In multivariate analyses p53 positive immunostaining was identified as an independent predictive factor for resistance to cisplatin-based chemotherapy (P=0.006). CONCLUSIONS: Our study confirmed an association of p53 immunostaining and response rate of patients treated with cisplatin-based chemotherapy.     

广东省四会市1987~2009年恶性肿瘤生存率分析

[目的]分析广东省四会市1987～2009年主要恶性肿瘤患者的生存状况,为肿瘤的预后评价和防控提供科学依据.[方法]收集并整理1987～2009年四会市全人群肿瘤登记数据共11 456例,随访截止日期为2014年12月31日.用Log-rank检验对各年龄组、性别组和各主要癌症不同确诊年份段的生存率进行比较.采用Cox回归模型进行多因素分析.[结果]23年间,四会市鼻咽癌、胃癌、结直肠癌、乳腺癌、肝癌、肺癌、宫颈癌、子宫体癌、甲状腺癌9种恶性肿瘤的5年OS有明显提高,差异有统计学意义(P＜0.05);而食道癌、膀胱癌、淋巴瘤、白血病的5年生存率在这3个年份阶段中的变化无统计学差异.各确诊年份段的女性生存率均高于男性,女性死亡风险是男性的0.77倍;≥70岁年龄组的死亡风险是＜40岁组的2.23倍;2007～2009年的死亡风险是1987～1996年的0.71倍.[结论]23年来,四会市全人群恶性肿瘤生存率有所提高,但与国外发达国家及国内其他地区比较仍处于较低水平,提示应重视其他主要癌症的早诊早治工作.     

SERO-EPIDEMIOLOGICAL STUDIES OF EPSTEIN-BARR VIRUS(EBV) INFECTION BY TESTING ANTIBODIES AGAINST EBV SPECIFIC DNASE(EDAb) AS A METHOD FOR EARLY DETECTION OF NASOPHARYNGEAL CARCINOMA(NPC)

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A comparison between ventricular and lumbar cerebrospinal fluid cytology in adult patients with leptomeningeal metastases

Leptomeningeal metastases (LMs) are common metastatic complications, occurring in at least 5% of patients with disseminated cancer. Cerebrospinal fluid (CSF) cytology remains the standard for diagnosis and assessment of treatment response, but may be inadequate. Our objective was to compare ventricular and lumbar CSF cytology in patients who had cytologically proven LM and were receiving intra-CSF chemotherapy. Sixty patients with LM, positive lumbar CSF cytology documented at diagnosis, limited extent of CNS disease, and no evidence of CSF flow obstruction were treated with a variety of intra-CSF chemotherapies. All patients underwent a single simultaneous ventricular and lumbar CSF sampling (mean volume of CSF per site examined, 10 ml) to assess response to therapy at either 1 or 2 months after treatment initiation. Ventricular CSF cytology was positive in 44 patients (73%), 35 of whom were also positive by lumbar CSF cytology. Lumbar CSF cytology was positive in 45 patients (75%), of which 35 were also positive by ventricular CSF cytology. Samples were negative at both ventricular and lumbar sites in 6 patients (10%). Paired CSF cytologies were discordant in 19 (32%) patients. The lumbar cytology was negative in 9, whereas the ventricular cytology was positive (lumbar false-negative rate of 17%); the ventricular cytology was negative in 10, whereas the lumbar cytology was positive (ventricular false-negative rate of 20%). In the presence of spinal signs or symptoms of LM, the lumbar CSF cytology was more likely to be positive than was the ventricular (odds ratio = 2.86; 95% confidence interval, 0.86-9.56). Conversely, in the presence of cranial signs or symptoms, the ventricular CSF cytology was more likely to be positive than was the lumbar (odds ratio = 2.71; 95% confidence interval, 0.76-9.71). In this cohort of patients, whose LM was documented initially by positive lumbar CSF cytology, ventricular and lumbar CSF samples obtained during treatment had similar false-negative rates, depending on the site of clinical or radiologic disease. This suggests that both lumbar and ventricular sites must be sampled when assessing treatment response. If clinical or radiographic disease is present only at 1 site, then CSF from that site is more likely to be positive than is CSF obtained from the more distant site.     

头颈鳞癌p53、Bcl-2及P-gp表达在治疗中的作用

目的 检测突变型p53、Bcl-2及P-gp蛋白在头颈鳞癌中的表达,探讨其在治疗中的作用.方法 97例头颈鳞癌中口咽癌18例、下咽癌27例、声门上喉癌52例,采用S-P法检测癌组织中p53、Bcl-2及P-gp蛋白表达,并结合治疗结果进行统计分析.结果 突变型p53、Bcl-2及P-gp蛋白在头颈鳞癌中的阳性表达率分别为69.07﹪、46.39﹪、50.52﹪.突变型p53蛋白阳性与阴性累计五年生存率分别为38.43﹪和75.86﹪.P-gP蛋白阳性与阴性分别为35.23﹪和63.15﹪,两者对比有统计学意义(P＜0.05).在单纯手术和术后放疗、化疗两组中,突变型p53蛋白阳性与阴性的五年生存率分别为40.77﹪和80.00﹪、25.63﹪和61.90﹪,对比均有统计学意义(P＜0.05).术后放疗、化疗组中Bcl-2和P-gp蛋白阳性与阴性的五年生存率分别为23.35﹪和48.83﹪、31.43﹪和60.53﹪,差别有统计学意义.结论 突变型p53、Bcl-2、P-gp蛋白阳性表达是抵抗放疗或化疗的生物学指标,在预测放疗、化疗敏感性方面有一定作用.