血清FPSA、TPSA在前列腺癌诊断及鉴别诊断中的应用

采用化学发光法（CLIA）测定78例健康人（对照组）、32例前列腺炎患者（炎症组）、138例前列腺增生患者（增生组）、34例前列腺癌患者（PCa组）的血清总前列腺特异性抗原（TPSA）、游离前列腺特异性抗原（FPSA）和FPSA／TPSA（F／T）值，并对结果进行比较。结果炎症组、增生组及PCa组FPSA及TPSA水平均升高，与对照组比较，P均〈0．01；其中PCa组显著高于炎症组及增生组，P均〈0．01。PCa组F／T值明显低于其他三组，P均〈0．01。认为血清FPSA、TPSA和F／T值联合检测，可明显提高PCa诊断及鉴别诊断的敏感性和特异性。     

血清PSA、PSAD和FPSA/TPSA在前列腺癌诊断中的应用

采用微粒子捕获酶免疫技术测定前列腺癌(PCA)、前列腺增生(BPH)、非特异性肉芽肿性前列腺炎(NSGP)患者及正常人血清的前列腺特异性抗原(PSA)、总PSA(TPSA)和游离PSA(FPSA)水平,并计算前列腺特异性抗原密度(PSAD)和FPSA/TPSA比值.结果 PCA组、BPH组、NSGP组PSA水平均明显高于对照组(P均<0.01),其中PCA组最高;TPSA在4～10μg/L时,PCA组与BPH组血清PSA水平无统计学差异(P>0.05),而FPSA/TPSA比值具有明显差异(P<0.01).认为联合检测PSAD、TPSA、FPSA和FPSA/TPSA可明显提高PCA诊断的准确性.     

PSA、FPSA／TPSA和PSAD在前列腺癌诊断中的价值

欧美国家男性泌尿生殖系肿瘤中前列腺癌最常见,近年来,我国发病率亦逐年上升。前列腺特异性抗原（PSA）是一种单体糖蛋白,其血清中的含量足前列腺癌诊断指标之一。PSA的应用使前列腺癌的检出率提高了70％,其流行病学也发生了重大改变。由于前列腺炎、前列腺增生患者的血清PSA也可升高,故PSA检测诊断前列腺癌的特异性不高。本文通过对105例前列腺癌患者和485例前列腺增生患者的血清PSA、血清游离前列腺特异性抗原／血清总前列腺特异性抗原（FPSA／TPSA）和前列腺抗原癌变（PSAD）的比较研究,进一步明确上述指标在前列腺癌诊断中的临床应用价值。     

血清前列腺特异性抗原、前列腺特异性抗原密度和高迁移率族蛋白B1诊断老年前列腺癌的价值

目的探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)和高迁移率族蛋白(HMG)B1用于老年前列腺癌的诊断价值。方法选择老年前列腺癌患者69例(前列腺癌组)、同期老年前列腺增生患者60例(前列腺增生组)及健康体检老年男性51例作为对照组。所有研究对象于清晨空腹采集外周静脉血,分离血清,采用酶联免疫吸附法(ELISA)测定血清PSA、PSAD和HMGB1含量。结果前列腺癌组血清PSA、PSAD和HMGB1水平明显高于前列腺增生组和对照组(前列腺增生组:t=29.674、25.212、23.665,对照组:t=35.654、36.293、30.286,均P<0.05);前列腺增生组血清PSA、PSAD和HMGB1水平明显高于对照组(t=27.203、22.603、19.910,均P<0.05)。PSA+PSAD+HMGB1联合诊断前列腺癌敏感度和特异度明显高于PSA、PSAD、HMGB1单独检测。PSA与PSAD、PSAD与HMGB1、PSA与HMGB1均呈正相关。结论老年前列腺癌患者血清PSA、PSAD、HMGB1水平明显升高,PSA+PSAD+HMGB1联合诊断具有较高的敏感度和特异度。     

前列腺特异抗原测定在前列腺良恶性疾病鉴别中的应用

目的　探讨前列腺特异抗原 (PSA)在前列腺增生 (BPH)与前列腺癌 (PCa)鉴别诊断中的作用。方法　检测 BPH组 62例与 PCa组2 9例患者血清 FPSA、TPSA及 F/T值 ,并根据 TPSA不同区段对两组患者的 FPSA、TPSA及 F/T值进行比较。结果　在诊断灰区两组 TPSA差别不显著 ,而 F/T值差别有显著性意义 (P<0 .0 1 ) ;在 TPSA<4.0μg/L区段 ,两组 TPSA及 F/T值差别均不显著 ;在 TPSA>1 0 .0μg/L区段 ,TPSA和 F/T值在两组间的差别均有显著性意义 (P<0 .0 1 )。结论　血清 PSA有助于前列腺癌的早期诊断 ,在诊断灰区 F/T值具有重要的参考价值。     

血清F/TPSA比值及PSAD在前列腺癌早期诊断中的临床分析

检测前列腺特异性抗原(PSA)用于前列腺癌(PCa)早期诊断和筛查已被国内外学者所接受.然而PSA属器官特异性抗原,而非PCa特异.研究发现血清中游离PSA(FPsA)与总PSA(TPSA)的比值(F/TPSA)及PSA密度(PSAD)对PCa的早期诊断有非常重要的意义.本文旨在探讨F/TPSA比值及PSAD在PCa早期诊断中的作用,为临床提供参考.     

血清 PSA、PSAD 检测在前列腺癌骨转移诊断中的价值

目的探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)检测在前列腺癌(PCa)骨转移诊断中的价值。方法经前列腺穿刺活检或手术后病理检查确诊的238例PCa患者,根据ECT、X线、CT及MRI结果诊断骨转移组112例、非骨转移组126例;分析血清PSA、PSAD水平与PCa骨转移的关系。结果以血清PSA>20 ng/m L为骨转移诊断标准,两组骨转移阳性率有统计学差异(P<0.05),其诊断骨转移敏感度性76.79%,特异性为82.54%。以血清PSAD>0.40 ng/(m L·cm3)为骨转移诊断标准,两组骨转移阳性率有统计学差异(P<0.05),其诊断骨转移敏感性82.14%,特异性为75.40%。以血清PSA>20 ng/m L联合PSAD>0.40 ng/(m L·cm3)为临界值诊断骨转移敏感性、特异性分别为82.14%和84.13%。应用ROC曲线确定诊断PCa骨转移的临界值,血清PSA为20 ng/m L,PSAD为0.40 ng/(m L·cm3)。结论血清PSA、PSAD均为判断PCa患者有无骨转移的可靠指标,PSA+PSAD联合检测有助于预测PCa骨转移。     

直肠指检对前列腺良恶性疾病血清前列腺特异抗原的影响

目的：探讨直肠指检对前列腺增生（BPH）与前列腺癌（PCa)患者血清前列腺特异抗原（PSA）的影响。方法：应用时间分辨荧光免疫分析法，分别于直肠指检前和直肠指检后1d,3d,5d,7d检测BPH组25例与PCa组23例患者的血清FPSA，TPSA及F／T值，结果：两组患者血清FPSA，TPSA及PCa组患者F／T值在直肠指检后1d升高，与直肠指检前比较差别有显著性意义（P＜0．01），3d后各项指标恢复至直肠指检前水平，结论：直肠指检对前列腺增生和前列腺癌患者血清PSA有一定的影响，PSA检测应在直肠指检前或直肠指检3－5d后进行。     

游离前列腺特异抗原与总前列腺特异抗原比值对老年前列腺癌的诊断价值

目的探讨游离前列腺特异抗原(fPSA)与总前列腺特异抗原(tPSA)比值对老年前列腺癌的诊断价值。方法依据病理检查结果分别选取61例前列腺癌(前列腺癌组)及61例良性病变患者(对照组)进行回顾性分析,比较两组fPSA、tPSA、fPSA/tP SA及前列腺特异性抗原密度(PSAD)水平。结果前列腺癌组tPSA及PSAD水平均显著高于对照组,fPSA/tPSA明显低于对照组(P0.05);前列腺癌组tPSA10μg/L、fPSA/tPSA0.16及PSAD≥0.15μg·L~(-1)·cm~(-3)例数均明显高于对照组(P0.05)。结论 tPSA、fPSA/tPSA及PSAD均可作为前列腺癌的诊断参考指标。     

血清tPSA、fPSA/tPSA及PSAD在前列腺良恶性疾病鉴别诊断中的价值

目的探讨血清总前列腺特异抗原（tPSA）、游离PSA（fPSA）与tPSA的比值（F／T）、前列腺特异抗原密度（PSAD）在前列腺增生（BPH）和前列腺癌（PCa）鉴别诊断中的价值。方法检测65例BPH患者及38例PCa患者的血清tPSA、fPSA,经腹部B超测定前列腺的前后径、左右径、上下径,并计算出F／T、前列腺体积（PV）及PSAD,进行比较。结果在灰区外高值区,tPSA、PSAD在两组间差异有显著性（P均〈0．01）,F／T差异无显著性（P〉0．05）;在灰区,两组间tPSA差异无显著性（P〉0．05）,而F／T、PSAD差异有显著性（P均〈0．01）;在灰区外低值区,tPSA、F／T及PSAD在两组间差异无显著性（P〉0．05）。结论以F／T及PSAD作为tPSA的辅助指标,对PSA灰区PCa的诊断具有明显临床意义。     

PVR和PSAD:前列腺癌与良性前列腺增生的鉴别

目的　探讨前列腺移行区体积 (TZV)与前列腺总体积 (PGV)的比值 ,即 TZV/ PGV=PVR和 PSA密度 (PSAD)鉴别前列腺癌(PCa)与良性前列腺增生 (BPH)的应用价值。方法　采用专用直肠超声探头检测 70例 PCa及 96例 BPH病人的前列腺 PZV及 PGV,并计算其体积比值 ,同时测量血 PSA值 ,计算 PSAD。结果　在 BPH与 PCa两组间 ,PSAD及 PVR有统计学意义 (P<0 .0 1 )。结论　 PVR和 PSAD对鉴别 PCa与BPH有较高的应用价值 ,可作为临床前列腺癌的初步筛选指标。     

血清IGF-1, IGFBP-3, PSA及fPSA在前列腺癌诊断中的意义

目的探讨胰岛素样生长因子-1（IGF-1）和胰岛素样生长因子结合蛋白-3（IGFBP-3）在前列腺癌（PCa）患者血清中的水平及其与前列腺特异抗原（PSA）、游离PSA（fPSA）联合检测的意义。方法采用化学发光法（CLIA）检测52例PCa患者、48例良性前列腺增生症（BPH）患者和48例健康对照者的血清IGF-1,IGFBP-3,PSA及fPSA水平。结果 PCa组IGF-1水平较BPH组、健康对照组明显升高（P＜0.01）,BPH组与健康对照组比较,差异无统计学意义（P＞0.05）;PCa组IGFBP-3水平低于BPH组和健康对照组（P＜0.01）,BPH组与健康对照组比较,差异有统计学意义（P＜0.01）。IGF-1及IGFBP-3诊断PCa的灵敏度分别为83.6%和76.4%,特异度分别为84.0%和74.0%,阳性预测值分别为85.2%和76.4%,阴性预测值分别为82.4%和74.0%。血清IGF-1与PSA或fPSA联合检测可明显提高诊断PCa的灵敏度。结论 PCa患者的IGF-1及IGFBP-3水平较健康对照者发生改变,IGF-1与PSA或fPSA联合检测更有助于PCa的诊断。     

经直肠超声前列腺癌声像特征及前列腺内腺PSA密度在前列腺癌诊断中的作用

目的通过经直肠超声分析前列腺癌声像特征并测量前列腺内腺、外腺与总体积，参考PSA探讨前列腺内腺PSA密度(IPSAD)在前列腺癌与前列腺增生鉴别诊断中的意义。方法回顾分析经直肠超声前列腺癌声像特征及经超声引导下6点活检病理诊断的49例前列腺癌、96例前列腺增生的临床资料。结果(1)前列腺癌声像特征以低回声为主，晚期可见被膜浸润及不规则。(2)前列腺内腺体积增生与癌有显著性差别。(3)PSA、PSA密度(PSAD)、IPSAD在增生与前列腺癌中的比较，均有显著性差异。(4)IPSAD在前列腺癌诊断的特异度为75．5％，敏感度为93．3％，优于PSAD。结论前列腺癌声像特征及IPSAD是鉴别前列腺癌与增生的重要指标。     

uPA/PAI-1 ratios distinguish benign prostatic hyperplasia and prostate cancer

Purpose

Urokinase plasminogen activator (uPA) and its inhibitor type 1 (PAI-1) are associated with tumour metabolism and are widely considered to be informative for the identification of cancer. We have analysed prostate tissue resections from patients with prostate cancer (PCa) and with benign prostatic hyperplasia (BPH) for protein levels of uPA and PAI-1, and searched for distinctions between these two clinical manifestations.

Methods

Prostate tissue was deep frozen in liquid N2 and homogenized in a stainless steel punch homogenizer. The tissue powder was extracted with a pH 8.5 TRIS/Triton X-100 buffer, and the extract analysed by FEMTELLE assay to generate uPA and PAI-1 readings in ng/mg protein. The uPA/PAI-1 ratio was calculated for each sample, and the mean ratios for the two diagnostic groups were compared.

Results

The concentration of uPA (mean ± SD) was found to be 0.19 ± 0.04 ng/mg protein (range 0.05–0.72 ng/mg) and 0.15 ± 0.02 ng/mg protein (range 0.03–0.78 ng/mg) in PCa and BPH samples, respectively. The concentration of PAI-1 was found to be 4.93 ± 0.90 ng/mg (range 1.10–11.80 ng/mg) and 5.87 ± 0.70 ng/mg (range 0.2–25.0 ng/mg) in PCa and BPH samples, respectively. A consistent finding being that PAI-1 concentrations exceed uPA concentrations by far giving rise to characteristic uPA/PAI-1 ratios. In BPH samples, there was a trend of PAI-1 to increase with uPA content, while in PCa samples, PAI-1 remained fairly constant. The mean uPA/PAI-1 ratio in PCa samples was found to be 0.06 ± 0.01 and was significantly higher than in BPH samples where the mean uPA/PAI-1 ratio was 0.03 ± 0.003 (p = 0.0028). R ² = 0.1389.

Conclusion

Using a contingent of 62 patients of which 46 were BPH and 16 were PCa, we report definitive concentrations of uPA and PAI-1 in tumour tissue extracts and show that the uPA/PAI-1 ratio emerges as a candidate marker to distinguish between BPH and PCa.     

前列腺癌组织中Ob—R和STAT3的表达变化及意义

目的观察瘦素受体（Ob—R）及信号转导和转录激活因子3（STAT3）在前列腺癌（PCa）组织中的表达,并探讨其临床意义。方法采用免疫组化法检测41例Pea（PCa组）、22例前列腺上皮内瘤（PIN,PIN组）、25例良性前列腺增生（BPH,BPH组）组织中Ob—R和STAT3。结果在BPH、PIN和PCa组中,Pb—R阳性表达率分别为56．00％（14／25）、72．73％（16／22）、90．24％（37／41）,PCa组与BPH组比较,P〈0．01,余组间两两比较,P均〉0．05;STAT3阳性表达率分别为60．00％（15／25）、81．82％（18／22）、87．80％（36／41）,PCa组与BPH组比较,P〈0．01,余组间两两比较,P均〉0．05。Oh-R的表达与PCa病理分级、临床分期无关,STAT3的表达仅与PCa病理分级有关（P〈0．05）。0b—R与STAT3表达呈正相关（r=0．6897,P〈0．01）。结论PCa组织中0b—R和STAT3呈高表达。Ob—R和STAT3可作为判断PCa生物学行为的指标。     

评价卧立位醛固酮与肾素比值诊断原发性醛固酮增多症的价值

目的 探讨高血压患者卧立位检测血浆醛固酮浓度(plasma aldosterone concentration,PAC）与血浆肾素浓度(plasma renin concentration, PRC)比值（ratio of aldosterone/rennin,ARR）对原发性醛固酮增多症（primary aldosteronism,PA）的诊断价值与临床应用。 方法 回顾性分析2018~2019年240例高血压卧立位试验阳性或可疑阳性患者,通过卡托普利试验阳性联合盐水负荷试验阳性确诊114例PA患者及126例原发性高血压（essential hypertension,EH）患者。采用化学发光法检测卧立位PAC及PRC,基于受试者工作特征曲线分析诊断PA卧立位PAC、ARR截断点,评价不同指标诊断PA的敏感性及特异性。 结果 PA组与EH组间年龄、性别等基线资料差异无统计学意义,以卡托普利试验联合盐水负荷试验同时阳性为诊断标准,卧位ARR诊断PA最佳截断点6.73,敏感度=79.8%,特异度=90.5%,ROC曲线下面积为0.916(95% CI:0.873,0.948）;卧位PAC诊断PA的截断点18.15,敏感度83.3%,特异度64.3%,ROC曲线下面积为0.777 (95% CI:0.719,0.828）;立位ARR诊断PA的截断点4.08,敏感度58.8%,特异度87.3%,ROC曲线下面积为0.798 (95% CI:0.742,0.847）;立位PAC诊断PA截断点24.39,敏感度69.3%,特异度74.6%,ROC曲线下面积为0.744 (95% CI:0.687,0.801）。 结论 卧立位ARR较卧立位PAC诊断PA的特异度强而敏感度差,综合两种体位下的激素检查结果可提高诊断PA的准确性。     

The use of prostate specific antigen (PSA) density in detecting prostate cancer in Chinese men with PSA levels of 4–10 ng/mL

Aim  To investigate the utility of prostate specific antigen density for detecting prostate cancer in men with serum PSA levels of 4–10 ng/mL. Methods  Between January 2003 and November 2007, 237 men (aged 48–84 years, median 71) with total PSA levels of 4–10 ng/mL participated in a protocol for prostate cancer screening. Eligible patients were recommended for transrectal ultrasonography (TRUS)-guided prostate biopsies after measuring prostate volumes transrectally. The diagnostic value of PSA levels and the free-to-total PSA ratio (f/tPSA), PSA densities (PSAD) were compared using receiver operating characteristic analysis. Results  Prostate cancer was diagnosed in 44 (18.6%) of the 237 men who had biopsies. There were significant differences between the groups in the prostate volumes determined by TRUS, PSAD, PSA levels and f/tPSA, whereas there was no significant difference in patient age. The area under the curve (AUC) of PSA (0.6786) and PSAD (0.717) was similar and significantly greater than that of f/tPSA (AUC 0.329). PSAD was a significantly better indicator of prostate cancer than f/tPSA. The sensitivity and specificity of PSA density at a cutoff of 0.134 ng/mL² was 90 and 33.7%, respectively. Conclusion  PSAD was a better predictor of prostate cancer in Chinese men with PSA levels of 4–10 ng/mL, especially those who have had prior ultrasound-determined measurements of prostate volume. Our data suggest that different PSAD cutoffs may need to be defined for Chinese.     

The use of procalcitonin in the diagnosis of late-onset infection in neonatal intensive care unit patients

We evaluated the semi-quantitative procalcitonin level for diagnosing late-onset infections in 176 neonates. Using a cut-off level of 0.5 ng/ml, the sensitivity was 84.4%+/-0.19, specificity was 93.9%+/-0.04, positive predictive value was 82.6%+/-0.1, and negative predictive value was 94.6%+/-0.04. Procalcitonin could be a useful marker of late-onset infection in neonates.     

Analysis of gland volume effect on the performance of PSA density in early detection of non-palpable,isoechoic prostate cancer

OBJECTIVE: To reassess PSA density (PSAD) in the detection of non-palpable, isoechoic prostate cancer and to analyze the effect of potentially inaccurate non-planimetric transrectal ultrasound volume estimates on the diagnostic performance of this diagnostic tool. METHODS: We prospectively evaluated 343 consecutive men with non-suspicious digital rectal examination and transrectal ultrasound findings and with serum PSA in the intermediate range (4.1-10 ng/mL). All men underwent systematic sextant biopsies of the peripheral zone. We performed a two-fold analysis of PSAD performance first using measured gland volume and then using modified gland volumes ranging from a 25% underestimation to a 25% overestimation, in 5% stepwise increments. RESULTS: With a 0.15 PSAD cut-off, we would have missed 14, 34 and 48% of cancers, if we had respectively used a volume underestimate of 25%, the measured volume and a volume overestimate of 25%. CONCLUSIONS: Potential gland volume under- or overestimation may substantially affect the diagnostic performance of PSAD. Although PSAD may represent a useful adjunct in the early detection of prostate cancer, it may compromise cancer detection in a substantial proportion of cases, if used as the only indicator for biopsy.