抗炎治疗后NIH-Ⅳ型前列腺炎患者血清PSA的变化

目的：探讨抗炎治疗后美国国立卫生院（NIH）-Ⅳ型前列腺炎患者血清前列腺特异性抗原（PSA）的变化.方法：对经筛选符合入选标准的68例、PSA增高（≥4 μg/L）、拟行前列腺穿刺活检的NIH-Ⅳ型前列腺炎患者,予左氧氟沙星（0.5,口服,1/d）＋复方磺胺甲恶唑片（SMZ）（1.0,口服,2/d）治疗2周,治疗后复查PSA和前列腺液（EPS）.分析PSA的变化及其与治疗效果（EPS中WBC≤10/HP为有效,WBC＞10/HP为无效）的关系.结果：68例患者治疗前PSA值为（9.76±4.26）μg/L,治疗后为（4.32±2.92）μg/L（P＜0.01）,其中治疗有效28例（P＜0.01）.治疗后PSA＜4 μg/L的患者26例,其中治疗有效23（P＜0.01）;治疗后仍PSA≥4 μg/L的患者42例,其中治疗有效5例.结论：抗炎治疗2周后患有NIH-Ⅳ型前列腺炎、PSA≥4 μg/L患者,血清PSA值明显下降,超过1/3患者血清PSA下降至正常而免于前列腺穿刺活检;PSA的下降与抗炎治疗效果相关.     

前列腺炎患者前列腺液成分与血清PSA含量的关系

目的 :探讨前列腺炎患者前列腺按摩液 (EPS)中卵磷脂小体及白细胞 (WBC)含量与血清前列腺特异性抗原(PSA)升高之间的关系 ,以及细菌性与非细菌性前列腺炎对血清PSA浓度的影响。　方法 :ELISA法测定 6 2例慢性前列腺炎患者及 2 2例正常人的血清PSA含量。分析EPS中卵磷脂小体及WBC含量与血清PSA升高的相关性 ,并比较细菌性与非细菌性前列腺炎患者平均血清PSA间的差异。　结果 :前列腺炎患者血清PSA含量为 (1.79± 0 .6 8)μg/L ,明显高于对照组的 (0 .6 3± 0 .2 9) μg/L (P <0 .0 0 1)。EPS镜检白细胞含量低的 (+～ ++)与含量高的 (+++～ ++++)两组患者的血清PSA含量比较差异有显著性 (P <0 .0 5 )。卵磷脂小体含量低的 (-～ ++) 35例与含量高的 (+++～ ++++) 2 7例患者的血清PSA含量比较差异无显著性 (P >0 .0 5 )。细菌性与非细菌性炎性前列腺炎患者血清PSA含量比较差异无显著性 (P >0 .0 5 )。　结论 :前列腺炎可以导致血清PSA升高 ,这种升高与EPS中WBC的含量呈正相关 ,与卵磷脂小体的含量无关 ,与前列腺炎类型 (细菌性或非细菌性 )无关。     

抗生素及非甾体类消炎药对ⅢA型前列腺炎血清PSA及游离PSA的影响

目的:探讨炎症性慢性骨盆疼痛综合征(ⅢA)患者经过抗生素及非甾体类消炎药治疗的血清前列腺特异性抗原(PSA)水平及游离PSA百分率(F-PSAR)的变化。方法:ⅢA型前列腺炎患者228例,应用抗生素及非甾体类消炎药治疗4周,测定患者治疗前、治疗结束后4周及8周的血PSA水平及F-PSAR,分析治疗前后血PSA水平及F-PSAR的变化。结果:在228例ⅢA型前列腺炎患者中,血PSA治疗前为(3.51±3.03)μg/L,治疗后第4周为(2.75±2.84)μg/L,较治疗前显著下降(P<0.05);而F-PSAR由治疗前0.25±0.05升至0.27±0.03。其中PSA≥4μg/L的患者占28.5%(65/228),在PSA≥4μg/L的患者中,PSA由治疗前(6.24±1.93)μg/L降至治疗结束后第4周(4.58±2.99)μg/L(P<0.05),PSA下降的幅度为(32.9±36.1)%;治疗后PSA<4μg/L患者占27.7%(18/65),F-PSAR由治疗前(16±9)%升至治疗结束后第4周(22±11)%(P<0.05),F-PSAR上升幅度为(51.4±25.8)%。上述指标在治疗后4周和治疗后8周差异无显著性(P>0.05)。结论:慢性前列腺炎亦是血PSA升高的原因之一。在明确前列腺炎的诊断后,可以给予有效的抗感染及抗炎治疗,能显著降低血PSA水平及提高F-PSAR。     

前列腺活检对血清T-PSA F-PSA及F/T比值的影响

目的 :研究经直肠前列腺穿刺活检对血清总前列腺特异抗原 (T PSA)、游离前列腺特异抗原 (F PSA)及游离 /总前列腺特异抗原 (F/T)比值的影响。方法 :对 36例前列腺活检示良性病变的患者 ,分别于活检前及活检后 0 .5h、1周、30d检测T PSA、F PSA值 ,并计算F/T比值。结果 :活检前及活检后 0 .5h、1周、30d患者血清T PSA分别为 (11.76± 7.82 ) μg/L、(36 .90± 2 4 .76 ) μg/L、(2 4 .36± 16 .18) μg/L和 (12 .2 1± 6 .4 9) μg/L ;F PSA分别为 (2 .4 1± 0 .96 ) μg/L、(2 5 .14± 12 .5 6 ) μg/L、(4 .0 2± 1.90 ) μg/L和 (2 .6 1± 0 .87) μg/L ;F/T比值分别为 0 .2 1± 0 .0 6、0 .6 8± 0 .18、0 .15± 0 .0 4和 0 .2 2± 0 .0 5。与活检前相比 ,活检后 0 .5h、1周T PSA、F PSA值显著升高 (P <0 .0 1、P <0 .0 5 ) ;F/T比值活检后 0 .5h显著升高 (P <0 .0 1) ,活检后 1周时显著降低 (P <0 .0 5 ) ;活检后 30d时 ,以上指标与活检前相比 ,差异均无统计学意义 (均P >0 .0 5 )。结论 :前列腺穿刺活检 ,会导致血清T PSA、F PSA及F/T比值的显著升高 ,临床上要获得有意义的PSA的指标 ,最好在活检 30d后检测     

良性前列腺增生并发急性尿潴留相关因素分析

目的 :探讨血清前列腺特异抗原 (PSA)和移行带指数 (TZI)与良性前列腺增生 (BPH)并发急性尿潴留 (AUR)的关系。　方法 :回顾性分析 6 0 2例BPH患者的相关资料。　结果 :BPH并发AUR组血清PSA值为 (6 .6 0± 3.4 0 )μg/L ,TZI值为0 .71± 0 .14 ;未并发AUR组患者血清PSA值为 (3.5 1± 2 .30 ) μg/L ,TZI值为0 .4 6± 0 .2 1。两组间血清PSA和TZI值差异均有显著性 (P均 <0 .0 5 )。PSA <4 .0、4 .0～ 10 .0、>10 .0 μg/L 3组间AUR发生率进行比较 ,差异有显著性 (P均 <0 .0 5 ) ,AUR发生率随血清PSA值的增高而增高。血清PSA与TZI呈显著正相关 (r=0 .2 13,P <0 .0 1)。　结论 :血清PSA和TZI可作为预测BPH并发AUR的良好指标     

急性尿潴留对血清前列腺特异性抗原的影响

目的 :研究良性前列腺增生 (BPH)病人发生急性尿潴留时对血清前列腺特异性抗原 (PSA)的影响。　方法 :对 34例伴有急性尿潴留的BPH病人 ,于膀胱造瘘前及引流尿液 4 8h后分别检测血清PSA值 (放免法 )。　结果 :BPH伴急性尿潴留者血清PSA值为 (2 4 6± 16 1) μg/L(2 .6～ 4 5 .8μg/L) ,引流尿液 4 8h后血清PSA值降为(9.4± 6 .3) μg/L(1.7～ 16 .6 μg/L)。两者相比 ,差异有显著性 (P <0 .0 1)。 　结论 :急性尿潴留可使BPH病人血清PSA值显著升高。尿潴留缓解后 ,血清PSA值平均下降超过 5 0 %。     

前列腺炎对血清PSA浓度的影响

目的 :探讨前列腺炎对血清 PSA浓度的影响。方法 :选择 48例 2 1～ 40岁的前列腺炎患者 ,用 EL ISA法测定直肠指检前的血清 PSA浓度 ,与正常组 2 1例对照 ,并对比治疗前后血清 PSA浓度的变化。结果 :前列腺炎组和对照组的血清 PSA浓度分别为 (1.5± 0 .4)和 (0 .4± 0 .2 ) μg/ L,两组间有极显著性差异 (t=11.96 ,P<0 .0 0 1) ;31例治疗有效者 ,治疗后血清 PSA浓度较治疗前明显下降 (P <0 .0 0 1) ,而 12例无效者 ,血清 PSA浓度较治疗前下降不明显 (P >0 .0 5 )。结论 :前列腺炎时血清 PSA浓度明显升高 ,但随着炎症的消失 ,PSA浓度可逐渐恢复正常。     

慢性前列腺炎患者前列腺液IL-6和IL-8表达变化及意义

目的　探讨慢性前列腺炎患者前列腺液中IL 6和IL 8的变化与慢性前列腺炎类型、症状和前列腺液白细胞计数的相关关系。　方法　以两杯法尿液细菌培养、前列腺液常规检查和NIH CPSI评分 ,将 10 2例前列腺炎患者分型。放免分析法测定患者和 2 8例正常对照者前列腺液中IL 6和IL 8含量 ,比较结果并进行相关分析。　结果　 90例前列腺炎患者 (Ⅱ、ⅢA、Ⅳ型 )前列腺液IL 6和IL 8水平分别为 ( 0 .5 1± 0 .5 7)ng ml和 ( 10 .75± 7.96 )ng ml,高于正常对照组的 ( 0 .32± 0 .5 1)ng ml和( 4.5 6± 5 .6 8)ng ml(P <0 .0 5和P <0 .0 1)。Ⅱ型前列腺炎患者前列腺液IL 6和IL 8水平与ⅢA型和Ⅳ型者比较差别无显著性意义 (P >0 .0 5 )。前列腺炎患者前列腺液白细胞计数与IL 8水平呈正相关(r=0 .5 2 9,P <0 .0 1)。前列腺液IL 6和IL 8水平与NIH CPSI评分无相关性 (P >0 .0 5 )。　结论　慢性前列腺炎患者前列腺液IL 6和IL 8表达增高 ,并参与前列腺的炎症反应。前列腺液IL 6和IL 8水平可作为慢性前列腺炎的诊断依据之一。     

直肠指检对PSA、F-PSA影响的研究

目的 :探讨直肠指检对前列腺特异抗原 (PSA)、游离前列腺特异抗原 (F PSA)的影响及其持续的时间。方法 :本组 5 1例 ,每例分别于直肠指检前、直肠指检后 1天、1周、4周抽取静脉血 2ml,采用放射免疫法测定PSA、F PSA。结果 :本组 5 1例直肠指检前血清PSA值为 0 .18～ 9.4μg/L ,平均2 .5 8± 2 .17μg/L ,F PSA值为0 .0 9～ 1.89μg/L ,平均0 .5 3± 0 .42 μg/L ,F/T比值为0 .0 6～ 0 .83,平均 0 .2 6± 0 .15 ;直肠指检后 1天、1周及 4周 ,PSA、F PSA及F/T比值虽然有所增高 ,但经统计学处理均无显著性意义。直肠指检前PSA <4.0 μg/L者 38例 ,PSA值平均为 1.5 0± 0 .92 μg/L ,PSA值≥4.0 μg/L者 13例 ,PSA值平均为5 .76± 1.5 4μg/L ;直肠指检后 1天、1周、4周 ,PSA、F PSA及F/T比值与检查前相比仍然没有统计学意义。结论 :只要检查过程中避免对前列腺作出强烈的挤压 ,常规的直肠指检对PSA、F PSA的影响极其轻微 ,且时间较短。     

选择性绿激光治疗前列腺增生症患者血清游离/总前列腺特异性抗原的变化

目的观察经尿道选择性绿激光前列腺汽化术(PVP)治疗前列腺增生症(BPH)患者,血清中的总前列腺特异性抗原(T-PSA)、游离PSA(F-PSA)水平和总/游离(F/T)PSA比值的变化,探讨其在PVP术后随访中的意义。方法对120例BPH患者行PVP治疗,采用化学发光免疫法分别检测术前1h、术后24h和1个月患者血清中的总PSA和游离PSA水平,并计算游离/总PSA比值,随访比较分析手术前后PSA变化差异。结果术后24h患者血清总PSA值平均为(15．5±8．4)μg/L及游离PSA值平均为(2．8±1．2)μg/L,均明显高于术前患者血清总PSA值(4．2±1．5)μg/L及游离PSA值(0．8±0．3)μg/L,差异有统计学意义(P＜0．05)。血清游离/总PSA比值术前术后比较差异无统计学意义(P＞0．05)。术后1个月血清总PSA值、游离PSA值及游离/总PSA比值与术前比较差异无统计学意义(P＞0．05)。结论与血清中的总PSA和游离PSA水平相比,血清游离/总PSA比值是PVP术后短期及长期随访的一个更可靠指标。     

慢性前列腺炎患者前列腺液中尿酸检测及临床意义

目的:检测慢性前列腺炎患者EPS中的尿酸(UA)水平并探讨其临床意义。方法:按NIH诊断标准确诊的91例慢性前列腺炎患者分为2组,ⅢA组(n=48)和ⅢB组(n=43)。对照组(n=22)为无慢性前列腺炎的健康志愿者。分别进行CPSI评分,EPS中WBC计数、pH值及UA浓度测定。结果:ⅢB组的EPS中UA浓度[(257.02±144.84)μmol/L]显著高于ⅢA组[(159.73±121.49)μmol/L,P<0.01]和对照组[(78.55±44.53)μmol/L,P<0.01]。EPS中UA水平与pH值之间呈负显著相关(r=-0.398,P<0.01),而与CPSI疼痛症状评分(CPSI-P)、排尿症状评分(CPSI-U)以及CPSI总分(CPSI-T)之间均呈显著正相关(r分别为0.436、0.316、0.403,P均<0.01)。结论:前列腺内的UA浓度升高可能会导致化学性炎症反应。EPS中的UA水平与慢性前列腺炎的症状相关。检测EPS中的UA水平对慢性前列腺炎的诊断和治疗具有重要意义。     

良性前列腺增生合并慢性前列腺炎的临床分析

目的:对良性前列腺增生(BPH)合并慢性前列腺炎的发病情况进行分析和探讨。方法:对213例已确诊为BPH患者进行前列腺按摩液(EPS)常规检查及EPS细菌培养,支原体、衣原体检测和血清PSA检测。对合并慢性前列腺炎的患者,进行抗炎治疗前后的BPH症状评分(IPSS)比较。结果:213例BPH患者中,合并慢性前列腺炎69例(32.4%),EPS细菌培养阳性27例(12.7%),EPS支原体、衣原体检测,15例阳性(7.0%)。合并慢性前列腺炎的患者中有7例PSA异常(>4μg/L)。69例合并慢性前列腺炎的患者经抗炎治疗后,IPSS由治疗前(12.2±2.6)分,降为治疗后(10.5±2.3)分,差异有显著性(P<0.01)。结论:BPH患者进行EPS检查,以明确是否合并有慢性前列腺炎,对临床上明确诊断、选择治疗药物或手术方式,提高疗效及减少并发症都有着重要意义。     

The prevalence of men with National Institutes of Health category IV prostatitis and association with serum prostate specific antigen

PURPOSE: We evaluated the prevalence and relationship of serum prostate specific antigen (PSA) levels in a screening population of men diagnosed with National Institutes of Health (NIH) category IV prostatitis. MATERIALS AND METHODS: In September of 2001, 300 men were randomly selected from our prostate cancer awareness screening program to be evaluated for NIH category IV prostatitis. After informed consent was obtained all patients completed the NIH prostate cancer awareness survey and had a serum sample obtained for PSA before examination. Expressed prostatic secretions were obtained from 227 of the 300 participants. Patients were classified according to findings on examination of the expressed prostatic secretions. The records were entered into our data base and subsequently reviewed. RESULTS: The prevalence of NIH category IV prostatitis was 32.2% in our population of men. Patient age, American Urological Association symptom scores and clinical prostate gland size did not differ between men with or without evidence of prostatitis on expressed prostatic secretion examination. Men with NIH category IV prostatitis had a mean serum PSA level of 2.3 which was significantly higher (p <0.0004) than those without prostatitis (mean PSA 1.4). CONCLUSIONS: These data suggest that NIH category IV prostatitis is fairly prevalent (32.2%) among men in the general population who present for prostate cancer screening and appears to contribute to increased serum PSA levels in some men.     

Prospective identification of National Institutes of Health category IV prostatitis in men with elevated prostate specific antigen

PURPOSE: Although prostatitis may cause elevated prostate specific antigen (PSA), asymptomatic patients are not routinely screened for this diagnosis before transrectal biopsy is performed to rule out cancer. Many negative biopsies reveal evidence of prostatitis classified as National Institutes of Health (NIH) category IV prostatitis or asymptomatic inflammation. To our knowledge this report represents the initial study of the incidence of NIH category IV prostatitis in men before biopsy and its clinical significance. MATERIALS AND METHODS: From 1996 to 1998 asymptomatic men with elevated PSA levels were evaluated for laboratory signs of prostatitis. Patients with expressed prostatic secretions or post-prostate massage urine (voiding bottle 3 [VB3]) positive for greater than 20 and greater than 10 white blood cells per high power field, respectively, received antibiotics for 4 weeks and were reevaluated after 6 to 8 weeks. Men without these clinical signs promptly underwent biopsy. Those with acute urinary tract infection and PSA greater than 30 ng./ml., without a rectum or who refused biopsy were excluded from study. RESULTS: Of the 187 study patients 122 were evaluable with a mean PSA of 9.35 ng./ml., including 51 (42%) with laboratory signs of prostatitis. After treatment PSA was normal in 22 cases and remained elevated in 29, including 9 in which biopsy revealed cancer. The change or improvement in PSA was significantly greater in men with benign results than in those with prostate cancer (-21.32 versus -1.33%, p = 0.001). In the cohort with negative expressed prostatic secretion and VB3 results transrectal ultrasound guided biopsy was done promptly. Screening decreased the number of biopsies by 18% (22 of 122 cases). The positive predictive value of PSA for detecting biopsy proved cancer improved with screening for prostatitis (45 of 122 cases or 37% versus 36 of 71 or 51%). Long-term followup revealed continued normal or stable PSA in the prostatitis cohort. CONCLUSIONS: Screening for NIH category IV prostatitis should be considered in men with elevated PSA. Although patients may be asymptomatic, anxiety caused by prostate cancer and diagnostic procedures contributes to the clinical significance of this disorder.     

Ⅳ型前列腺炎与前列腺特异性抗原的关系

目的 探讨Ⅳ型前列腺炎与前列腺特异性抗原(PSA)的关系. 方法回顾性分析245例前列腺疾病患者的临床病理资料,患者平均年龄68(32～87)岁,均无前列腺癌和穿刺活检史,均行PSA、全身骨扫描、磁共振成像(MRI)和前列腺穿刺活检.结果 245例经病理证实为良性前列腺增生(BPH)118例(48%)、BPH合并Ⅳ型前列腺炎(CP)127例(52%).BPH组患者f-PSA、t-PSA、f/t-PSA平均值分别为(1.70±1.70)、(9.40±8.10)ng/ml和0.19±0.09;合并CP组平均值分别为(2.83±4.37)、(16.87±20.51)ng/ml和0.20±0.14,2组比较差异有统计学意义(P＜0.05).多元线性回归分析结果显示t-PSA(P＜0.001)、f-PSA(P=0.003)和f/t-PSA(P=0.04)是BPH和CP最相关的指标.通过ROC曲线确定上述敏感指标的界值,以f-PSA≥0.85为界值诊断Ⅳ型前列腺炎的敏感度为77%,特异度为25%,ROC曲线下面积为0.60(P=0.014);t-PSA≥4.00 ng/ml为界值诊断Ⅳ型前列腺炎的敏感度为94%,特异度为20%,ROC曲线下面积为0.65(P=0.014);f/t-PSA≤0.16为界值诊断Ⅳ型前列腺炎的敏感度为56%,特异度为64%,ROC曲线下面积为0.61(P=0.003).结论 Ⅳ型前列腺炎是PSA升高的原因之一,以血清PSA作为前列腺癌的筛选指标时,应充分考虑前列腺炎的影响.对前列腺活检标本的病理报告,应包括对前列腺炎症的详细描述.     

慢性前列腺炎/慢性骨盆疼痛综合征患者前列腺液中IFN-γ、TGF-β_1的检测

目的:探讨干扰素γ(IFN-γ)和转化生长因子β1(TGF-β1)在慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)患者前列腺液中的临床意义。方法:采用双抗体夹心法对20例炎症性慢性骨盆疼痛综合征(ⅢA)、20例非炎症性慢性骨盆疼痛综合征(ⅢB)、10例健康对照者前列腺按摩液(EPS)中IFN-γ、TGF-β1含量进行测定。并与患者的美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)进行相关性研究。结果:IFN-γ、TGF-β1在ⅢA[(14.92±7.85)、(8 477.50±4 612.45)ng/L]和ⅢB[(13.74±5.96)、(7 946.50±5 044.06)ng/L]患者EPS中水平均明显高于健康对照组[(7.47±1.49)、(2 462.50±985.31)ng/L](P<0.05和P<0.001)。但在ⅢA和ⅢB之间差异无显著性(P>0.05)。EPS中IFN-γ、TGF-β1的水平与慢性前列腺炎症状指数无相关性(r=0.02,P=0.86;r=0.31,P=0.76)。结论:前列腺液中细胞因子IFNγ-、TGF-β1在CP/CPPS的病理学改变中可能起重要作用,可作为CP/CPPS的诊断依据之一。     

A proposal of subcategorization of bacterial prostatitis: NIH category I and II diseases can be further subcategorized on analysis by therapeutic and immunological procedures

Aim: We propose preliminarily that acute (category I of the NIH consensus definition) and chronic prostatitis (category II) can be subcategorized into primary and recurrent diseases based on the precise analysis of the clinical course and the immunological parameters in prostatic secretions of our cases. Methods: Five patients with stone‐free, acute febrile prostatitis and nine patients with acute episodes of afebrile urinary infection were included. The expressed prostatic secretions (EPS) were collected soon after the acute illnesses subsided after medication administration and they were examined microscopically, bacteriologically, and serologically. First‐line medications were cefem antibiotics with conventional doses for febrile cases and low doses for afebrile cases. They were administered for at least 2 weeks. Second‐line conventional medication with sulfamethoxazole‐trimethoprim or levofloxacin was given only to the patients in whom remaining prostatic infections were revealed. Results: The first‐line medications were successful in all patients and they promptly became asymptomatic in 1 week. All the EPS were infected except for two afebrile cases. Prostatic infections were eradicated by second‐line conventional medications. In a patient with afebrile prostatitis whose EPS were free of macrophages and immunoglobulin (Ig)M, the eradication of prostatic pathogens was achieved without second‐line antibacterial medication. Conclusions: Bacterial prostatitis could be classified into primary and recurrent chronic infections in each of the febrile (category I) and afebrile (category II) illnesses. A cefem regimen in varying doses was a clue for differential diagnosis as it did not affect the pathogens in the prostatic ducts or acini unless heavy urine reflux occurred in the ductal draining systems. Macrophages and immunoglobulins, especially IgM, in the EPS were useful immunological parameters to differentiate primary and recurrent infections of the prostate. Fluoroquinolones or sulfamethoxazole‐trimethoprim should not be employed in acute urinary infections in male patients until the confirmation of prostatic infection to avoid injudicious use of them, which might cause an increasing prevalence of resistant uropathogens in the community. The evacuation of the prostate by repetitive massage seemed to be effective to enhance the prompt eradication of pathogens from the prostatic tissue and to keep patients asymptomatic throughout the course of the disease by preventing tissue pressure elevation.     

Effect of NIH-IV prostatitis on free and free-to-total PSA

OBJECTIVE: To examine the effect of asymptomatic prostatic inflammation (NIH category IV prostatitis) on total PSA (tPSA), free serum PSA (fPSA) and the ratio of free-to-total prostate specific antigen (%fPSA). The role of free and %fPSA as a diagnostic tool for distinguishing between cancer and non-malignant diseases of the prostate was also investigated. MATERIAL AND METHODS: In a retrospective study 1090 prostate biopsies performed between January 2000 and September 2003 were evaluated and the levels of serum total and free PSA as well as the f/tPSA ratio were determined in samples obtained immediately before biopsy. 404 patients with full clinical and histological records were included in the study. All patients underwent 6 or 8 core primary prostate needle biopsies. RESULTS: A total of 404 patients were included in the analysis. 100 prostate cancer (PCa) (24.8%), 137 NIH-IV prostatitis (33.9%) and 143 patients with benign prostatic hyperplasias (BPH) (35.4%) were identified. 24 (5.9%) patients presented with both PCa and prostatitis on histology and were excluded from further analysis. The mean (median) levels of tPSA, fPSA and %fPSA were 11.94 ng/ml (8.0), 1.31 ng/ml (1.07) and 0.15 (0.14) for NIH-IV prostatitis; 11.94 ng/ml (8.35), 1.54 ng/ml and 0.13 (0.11) for prostate cancer; and 8.19 ng/ml (7.0), 1.48 ng/ml (1.03) and 0.18 (0.15) for BPH. No significant difference was found in tPSA levels between PCa and prostatitis (p = 0.32), while the difference in tPSA levels between PCa and BPH was significant (p = 0.007). Free PSA alone had no diagnostic power in distinguishing PCa from prostatitis (p = 0. 37) and BPH (p = 0. 61). By contrast, the f/tPSA ratio showed significant between-group differences (PCa versus prostatitis (p = 0. 011), PCa versus BPH (p = 0.0001). CONCLUSIONS: Chronic asymptomatic prostatitis NIH category IV has similar effects on total PSA and free PSA levels in serum as PCa. fPSA alone cannot distinguish prostate cancer from non-malignant inflammatory disease of the prostate. The ratio of free-to-total PSA is significantly different in PCa and NIH category IV prostatitis.     

慢性前列腺炎患者前列腺按摩液中C反应蛋白测定的临床意义

目的:本研究探讨了慢性前列腺炎(CP)患者前列腺按摩液(EPS)中C反应蛋白(CRP)水平与CP类型、EPS中的白细胞(WBC)计数、卵磷脂小体(LLZXT)、慢性前列腺炎症状指数评分(CPSI)之间的相关关系。方法:按照NIH分类标准,根据EPS常规检查和"二杯法"细菌培养,诊断CP患者196例,其中慢性细菌性前列腺炎(Ⅱ型)68例,炎症性慢性非细菌性前列腺炎/慢性骨盆疼痛综合征(ⅢA型)76例,非炎症性慢性非细菌性前列腺炎/慢性骨盆疼痛综合征(ⅢB型)52例,50例健康志愿者作为正常对照组。应用免疫比浊法对196例CP患者EPS中CRP含量进行检测。结果:结果显示,CP组浓度[(2.945±1.996)mg/L]明显高于对照组[(1.101±0.440)mg/L](P<0.01)。Ⅱ型组、ⅢA型组、ⅢB型组呈现从高到低的变化规律,其中Ⅱ型组与ⅢA型组无统计学差异(P=0.058),Ⅱ型组、ⅢA型组与ⅢB型组差异有显著性(P<0.01)。LLZXT与CRP含量呈负相关(r=-0.33,P<0.01)。WBC计数与CRP含量呈正相关(r=0.63,P<0.01)。NIH慢性前列腺炎症状指数评分前6项(NIH-CPSI6)与CRP含量正相关(r=0.28,P<0.01)。结论:本研究表明,EPS中CRP水平在慢性前列腺炎的发病过程中起重要作用,检测EPS中的CRP水平不仅可作为慢性前列腺炎诊断与分型的依据,而且可望作为慢性前列腺炎疗效评价的客观指标。