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目的 探讨同时应用VCA IgA、EA IgA和EA IgG三项检测在血清学诊断鼻咽癌中的效益。方法 收集 2 6 6例未经治疗的鼻咽癌患者和 347例健康成人的血清。用免疫酶法检测VCA IgA ,用酶联免疫吸附法 (ELISA)替代免疫酶法检测EA IgA和EA IgG抗体。应用新的统计学方法来评估这三项检测的不同优势比。结果 同时应用VCA IgA、EA IgG和EA IgA三项检测的灵敏度和特异度分别为 95 .11%和 97.4 1% ,高于这三项检测的单独应用 (VCA IgA为 90 .6 0 %和 94 .5 2 % ,EA IgG为93.98%和 93.6 6 ,EA IgA为 89.84 %和 88.18% )。再者 ,VCA IgA、EA IgG和EA IgA三项检测均呈阳性者的优势比 (1912 .5 )远远高于其中两项检测呈阳性者 (VCA IgA和EA IgG为 2 7.90 32 ;EA IgG和EA IgA为 11.16 90 ;VCA IgA和EA IgA为 8.0 32 8) ,而两项检测阳性的优势比又高于单个检测阳性者(VCA IgA为 0 .12 14 ;EA IgG为 0 .170 5 ;EA IgA为 0 .0 4 88)。结论 ELISA法较免疫酶法更能确切反映血清中EB病毒早期抗原的抗体水平。VCA IgA、EA IgG和EA IgA的联合应用能显著提高灵敏度和特异度 ,明显增高检测阳性的优势比 ,因此 ,能有效地提高EB病毒血清学在诊断鼻咽癌时的效益。
Objective To investigate the efficacy of simultaneous application of VCA IgA, EA IgA and EA IgG in serological diagnosis of nasopharyngeal carcinoma. Methods Serum from 266 untreated NPC patients and 347 healthy adults were collected. VCA IgA was detected by immunoenzymatic method and EA IgA and EA IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA) instead of immunoenzymatic method. New statistical methods were used to evaluate the different odds ratios for these three tests. Results The sensitivity and specificity of simultaneous detection of VCA IgA, EA IgG and EA IgA were 95.1 1% and 97.4 1% respectively, higher than those of the three tests (VCA IgA 90.60% and 94% .52%, EA IgG 93.98% and 93.66, EA IgA 89.84% and 88.18%). In addition, the odds ratio (1912.5) of VCA IgA, EA IgG and EA IgA were significantly higher than that of two of them (VCA IgA and EA IgG 2 7.90 32; EA IgG And EA IgA was 11.16 90; VCA IgA and EA IgA were 8.0 32 8), while the positive odds ratio of the two tests was higher than that of single test positive (VCG IgA was 0.12 14; EA IgG was 0.1705; EA IgA was 0.048 88). Conclusion Compared with the immunoenzymatic method, the ELISA method can accurately reflect the antibody level of the early antigen of Epstein-Barr virus in serum. The combined application of VCA IgA, EA IgG and EA IgA can significantly improve the sensitivity and specificity, and significantly increase the odds ratio for positive detection. Therefore, the efficacy of EBV serology in the diagnosis of nasopharyngeal carcinoma can be effectively improved.