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頁籤選單縮合
題名 | Clinical Application of Two New Serological Tests of Epstein-Barr Virus in Nasopharyngeal Carcinoma=兩種新EB病毒血清檢查法在鼻咽癌之臨床應用 |
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作者 | 徐茂銘; 沈宗憲; 柯政郁; 婁培人; Hsu, Mow-ming; Sheen, Tzung-shiahn; Ko, Jenq-yuh; Lou, Pei-jen; |
期刊 | 中華民國癌症醫學會雜誌 |
出版日期 | 20010600 |
卷期 | 17:2 2001.06[民90.06] |
頁次 | 頁17-25 |
分類號 | 416.879 |
語文 | eng |
關鍵詞 | 鼻咽癌; 酵素免疫法; EB病毒核抗原-1; Nasopharyngeal carcinoma; ELISA test of EB virus; Real-time quantitative PCR; |
中文摘要 | 目的:本文之目的在研究酵素免疫法(ELISA),以分子生物學合成EB病毒早期抗原(EA)和EB病毒核抗原-1(EBNA-1)為抗原,檢測血清中之1gA抗體,以及即時定量聚合脢反應法(RTQPCR)測量血清中EB病毒的數目,在鼻咽癌之臨床應用。 材料及方法:鼻咽癌137名、其他頭頸癌19名、對照組149名,共305名之血清進行ELISA之檢查,其中在30名鼻咽癌新病人,由治療之初,就開始抽血,且在其病程演變過程中多次抽血保存,以觀其ELISA測出特異性IgA抗體之起伏動態。常規螢光抗體法測定不同EB病毒抗原之IgA抗體,也同時檢測以作為比較。PTQPCR共檢測87名,其中鼻咽癌42名、其他頭頸癌症24名,鼻咽淋巴組織增生者21名。 結果:ELISA 對鼻咽癌測定之敏感率、特異率、正確率分別為97.5%、81.9%、89.6%,比任何螢光抗體法優異。多項變異分析獲知IgA抗體效價昇高者和鼻咽癌病人T4(p=.0133)、N3(p=.0244)、M1(p=.0001) 和第四期 (p=.0485) 有統計學上之相關性。30名長期測量其血清中之IgA抗體效價,除1名本來就陰性以外,均隨腫瘤之消退而下降。但當臨床上都無腫瘤存在時,其IgA抗體仍屬陽性,顯示ELISA不宜做為治療反應之監視指標。在83.3% 之鼻咽癌病人,血清中用RTQPCR可測得EB病毒DNA,其中尤以28名未治療之鼻咽癌,每ml血清EB病毒數目推估由2,370至7,227,325不等,而且和臨床病期成正比,即晚期病人之血清中EB病毒數目較高。6名鼻咽癌緩解病人,23名其他頭頸癌以及17名鼻咽淋巴組織增生者均無法測到其血清中之EB病毒。 結論:ELISA 利用合成之 EB 病毒 EA 和 EBNA-1 當雙重抗原測定 IgA 抗體, 可作鼻咽癌早期診斷以及高危險群大型篩檢鼻咽癌之用。 RTQPCR 有可能當作監測鼻咽癌對治療反應之新臨床指標。 |
英文摘要 | Purpose: To assess the clinical application of an ELISA test to measure the specific Ig A antibodies against the recombinant Epstein-Barr virus (EBV) early antigen (EA) and EBV nuclear antigen-1 (EBNA-1) and a real-time quantitative polymerase chain reaction (RTQPCR) to examine serum EBV DNA in patients with nasopharyngeal carcinoma (NPC). Materials and methods: A total of 305 persons consisted of NPCs 137, other head and neck cancers 19, and controls 149 was examined of EBV Ig A antibodies by using an ELISA kit. The sera of 30 NPC patients were obtained at multiple occasions during their clinical course and were examined using the ELISA test as well. Fluorescence antibody (FA) tests of Ig A antibodies against EBV viral capsid (VCA) and EA antigens were also done for comparison. Real-time quantitative PCR was studied in 87 persons including 42 patients with NPC, 24 with other head and neck cancer, and 21 with nasopharyngeal lymphoid hyperplasia. Results: The sensitivity, specificity and accuracy of the ELISA test for NPC were 97.5%, 81.9%, and 89.6%, respectively. It is far better than two FA tests. The Ig A antibody titers showed statistically significant association between high titers and NPC patients with T4 (p=.0133), N3 (p=.0244), M1 (p=.0001), or stage IV (p=.0485) disease in multivariate analysis. Serial testing of antibody titers in 30 previously untreated NPC patients found a trend of decreasing Ig A antibody titers after initial treatment when the tumor disappeared. However, they still appeared positive of Ig A antibody titers in all except one in the state of clinical remission. The results of real-time quantitative PCR revealed detectable EBV DNA in sera of 35 (83.3%) out of 42 NPC patients. The copy numbers of EBV were estimated ranging from 2,370 to 7,227,325 per ml of serum in 28 previously untreated NPC patients and were likely correlated to clinical staging, i.e. higher viral copy number found in advanced-stage patients. Sera of 6 NPC patients in remission, 23 patients with other head and neck cancer and 17 patients with nasopharyngeal lymphoid hyperplasia failed to detect EBV DNA. Conclusion: The ELISA kit to identify specific Ig A antibodies to the combination of EBV EA and EBNA-1recombinant antigens should be useful for early diagnosis and mass screening of NPC. Real-time quantitative PCR of EBV DNA may be a new clinical parameter to monitor the clinical outcomes in NPC treatment. |
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