抗炎治疗后亚临床型前列腺炎患者血清PSA变化及其临床意义

目的 探讨抗炎治疗后亚临床型前列腺炎患者血清PSA变化及其临床意义.方法 直肠指检阴性的亚临床型前列腺炎患者136例.实验窒检查PSA 4.2～49.7(14.0±7.8)ng/ml.136例予抗炎治疗后2周复查PSA并在B超引导下行前列腺穿刺活检.评估抗炎治疗前后PSA、PSA密度(PSAD)、游离/结合PSA(f/t PSA)及其变化(△PSA、△PSAD、△f/t PSA),受试者工作特征(ROC)曲线分析抗炎前后各参数对前列腺癌的诊断效力.采用SPSS 11.0软件对组间行t检验.结果 136例穿刺活检诊断为前列腺癌33例.良性病变103例.抗炎治疗前后相比:PSA由(14.0±7.8)ng/ml降至(10.4±7.7)ng/ml、PSAD从(0.24±0.12)ng·ml1·ml~(-1)降至(0.18±0.12)ng·ml~(-1)·ml 1、f/t PSA从0.23±0.08降至0.16±0.07,治疗前后比较差异均有统计学意义(P＜0.05).△PSA、△PSAD和△f/tPSA分别为(-3.59±4.34)ng/ml、(-0.10±0.09)ng·ml-1·ml-1及-0.06±0.05.抗炎治疗前PSA、PSAD和f/t PSA诊断前列腺癌ROC曲线下面积分别为0.288、0.642和0.504,△PSA、APSAD和△f/tPSA诊断前列腺癌ROC曲线下面积分别为0.910、0.957和0.983,与治疗前比较差异均有统计学意义(P值均＜0.01).结论 亚临床型前列腺炎伴有PSA增高者经抗炎治疗2周后血清PSA明显下降;利用抗炎治疗后△PSA、APSAD、△f/t PSA可提高前列腺癌的诊断率,减少不必要的前列腺穿刺活检.

Clinical significance of PSA changes in asymptomatic prostatitis patients after antibacterial treatment

Objective To evaluate the clinical significance of PSA changes in asymptomatic prostatitis patients after antibacterial treatment. Methods A cohort of 136 asymptomatic prostatitis patients with mean PSA 14.0±7.8 ng／ml(range 4.2-49.7 ng／m1)and normal digital rectal exami- nation findings were included.All these patients underwent antibacterial therapy for 2 weeks before they had repeated PSA tests and transrectal-ultrasound guided prostate biopsies.The changes of PSA. PSA density(PSAD)and free／total PSA ratio(f／t PSA)were assessed.The effectiveness of PSA. PSAD and f／t PSA ratio after antibacterial treatment and their changes(△PSA,△f／t PSA, △PSAD)on prostate cancer detection were analyzed using the receiver operating characteristics (ROC)technique.Data were analyzed by SPSS 1 1.0 software. Results Of the 1 36 patients accep- ting prostate biopsies,33 patients were diagnosed with prostate cancer and the other 103 patients were histologically confirmed with benign prostatic disease.After 2 weeks antibacterial treatment.the PSA level dropped from 14.0±7.8 ng／ml to 10.4±7.7 ng／ml(P<0.01);The PSAD changed from 0.24 ±0.12 ng／ml／ml to 0.18±0.12 ng／ml／ml(P<0.05)and f／t PSA ratio changed from 0.23±0.08 to 0.16±0.07(P<0.05);The△PSA,△PSAD and△f／tPSA were-3.59±4.34 ng／ml,-0.10±0.09 ng／ml／ml and-0.06±0.05.respectively.The areas under ROC curve of APSA,APSAD,△f／t PSA,which improved the efficiency of prostate cancer detection significantly when compared with those parameterS before antibacterial treatment.were 0.910.0.957 and 0.983,respectively(all the P values<0.01). Conclusions The PSA value changes significantly after 2 weeks antibacterial treatment for asymptomatic prostatitis patients with PSA≥4 ng／ml.By using the parameters after an- tibacterial treatment,△PSA,△PSAD and△f／t PSA can improve the prostate cancer detection rate and decrease the unnecessary prostate biopsy.