1.Qingdao Medical College of Qingdao university;2.Linyi People,s Hospital
评估EB病毒相关血清学标志物Rta蛋白IgG抗体（Rta/IgG）、衣壳抗原IgA抗体（VCA/IgA）、早期抗原IgA抗体（EA/IgA）联合检测在临沂地区鼻咽癌(NPC)筛查中的应用价值。方法 收集2019.10-2022.10间在临沂市人民医院体检的体检组15873例、有鼻咽部相关临床症状的临床筛查组1800例、经病理科确诊为NPC的确诊组48例研究对象的临床资料，采用酶联免疫法分别检测其血清中Rta/IgG、VCA/IgA、EA/IgA三项抗体水平，将检测结果绘制成ROC曲线并进行统计学分析，评价三项指标单独检测及联合检测对NPC的诊断价值。结果 Rta/IgG、VCA/IgA、EA/IgA在确诊组阳性率分别为72.90%(35/48)、85.41%（41/48）、85.41%（41/48），在临床筛查组阳性率分别为17.17%(309/1800)、27.06%(487/1800)、17.72%(319/1800)，在体检组阳性率分别为10.34%(1642/15873)、19.30%(3070/15873)、9.96%(1581/15873)，确诊组阳性率明显高于临床筛查组（Χ2分别为95.918、78.029、136.589， Ｐ均< 0.01）及体检组（Χ2分别为198.823、132.894、297.787，Ｐ均< 0.01),差异均有统计学意义；Rta/IgG、VCA/IgA、EA/IgA的灵敏度分别为72.90%、85.41%、85.41%，特异度分别为89.0%、79.9%、89.2%。三项抗体联合检测时其灵敏度及特异度分别为95.83%（46/48）和99.12%(17518/17673)；且ROC曲线下面积AUC为0.949，均高于三项抗体单独检测值（0.846、0.901、0.916）。结论 Rta/IgG、VCA/IgA、EA/IgA三项抗体的联合检测可更大范围的反应EB病毒潜伏期及溶解期的抗原表达，具有很好的互补作用，明显提高了NPC的检出率。
Objective To evaluate the value of the combination of EB serological marker Rta protein IgG antibody (Rta / IgG), capsid antigen IgA antibody (VCA / IgA) ，early antigen IgA antibody (EA / IgA) in NPC screening in Linyi area. Methods From October 2019 to October 2022, the clinical data of 15873 subjects in physical examination group, 1800 subjects in clinical screening group with nasopharyngeal symptoms and 48 subjects in final diagnosis group with nasopharyngeal carcinoma confirmed by pathology in People's Hospital of Linyi Citywere collected,and draw the levels of the Rta / IgG, VCA / IgA and EA / IgA in the serum into the ROC curve and make statistical analysis to evaluate the diagnostic value of the three indexes and combined detection for nasopharyngeal carcinoma. Results The positive rates of Rta / IgG,VCA / IgA and EA / IgA in the confirmed group were 72.90% (35 / 48), 85.41% (41 / 48), 85.41% (41 / 48), respectively, In the clinical screening group, the positive rates were 17.17% (309 / 1800), 27.06% (487 / 1800), and 17.72% (319 / 1800), respectively, In the physical examination group, the positive rates were 10.34% (1642 / 15873),19.30% (3070 / 15873) , and 9.96% (1581 / 15873), respectively, The positive rate of the confirmed group was significantly higher than that of the clinical screening group（Χ2=95.918,78.029 and 136.589 , respectively, (Ｐ<0.01) and the physical examination group (Χ2=198.823, 132.894and 297.787, respectively, ( Ｐ<0.01), The differences were all statistically significant; Sensitivity of Rta / IgG,VCA / IgA and EA / IgA were 72.90%, 85.41%, 85.41%, respectively, The specificity were 89.0%, 79.9% and 89.2% , respectively. The sensitivity and specificity of the three antibodies were 95.83% (46 / 48) and 99.12% (17518 / 17673), respectively; and the area under the ROC curve AUC was 0.949, which was higher than the three antibodies alone (0.846,0.901 and 0.916). Conclusion The combined detection of Rta / IgG, VCA / IgA and EA / IgA can increase the antigen expression in the latency and lysis period of EB virus, which has a good complementary effect and significantly improves the detection rate of nasopharyngeal carcinoma.