PSA相关参数对血清PSA灰区前列腺癌的诊断价值——附126例报告

目的：探讨血清总前列腺特异性抗原（tPSA）与游离PSA（fPSA）比值（f/tPSA）、血清PSA（sPSA）与尿PSA（uPSA）比值（s/uPSA）、前列腺特异抗原密度（PSAD）等PSA相关参数对sPSA灰区（4.0～10.0μg/L）前列腺癌的诊断价值。方法：126例sPSA4.0～10.0μg/L的前列腺疾病患者用化学发光法检测血清tPSA（即sPSA）、fPSA及uPSA,计算f/tPSA、s/uPSA。运用直肠超声测定前列腺体积,计算PSAD。根据穿刺或术后病理活组织检查结果分为前列腺癌组（40例）和BPH组（86例）,比较两组的sPSA、uPSA、PSAD、f/tPSA、s/uPSA。绘制sPSA、PSAD、f/tPSA、s/uPSA诊断前列腺癌的受试者工作特征（ROC）曲线,分析各参数的ROC曲线下面积。结果：前列腺癌组与BPH组的sPSA及uPSA水平接近（P〉0.05）,而前列腺癌组的s/uPSA及PSAD均比BPH组增高（P〈0.01或0.05）,其f/tPSA则比BPH组降低（P〈0.05）。各参数诊断前列腺癌的R0C曲线下面积从大到小依次为s/uPSA（0.776）、PSAD（0.719）、f/tPSA（0.715）、sPSA（0.668）。结论：对sPSA处于4.0～10.0μg/L诊断灰区的前列腺疾病患者,s/uPSA、PSAD、f/tPSA可比sPSA更好地检出前列腺癌,其中以s/uPSA的诊断价值最高。

Role of PSA-related indexes in diagnosing prostate carcinoma within serum PSA gray zone:a report of 126 cases

Objective：To explore the role of prostate specific antigen（PSA）-related indexes such as the ratio of free PSA and total PSA（f/tPSA）,ratio of serum PSA and urine PSA（s/uPSA）,PSA density（PSAD）in diagnosing prostate carcinoma（PCa） when serum PSA（sPSA） concentration is within 4.0～10.0 μg/L.Methods：One hundred and twenty-six patients with prostatic diseases were enrolled and their serum tPSA、fPSA,urine PSA（uPSA） were detected with chemoluminescence-assay method.f/tPSA,s/uPSA and PSAD were calculated.Patients were divided into benign prostate hyperplasia group（BPH group,n=86） and PCa group（n=40） according to the pathologic diagnosis which were made through biopsy or postoperative examination of specimen.The data of sPSA,uPSA,PSAD,f/tPSA,s/uPSA were compared between these two groups.Receiver operating characteristic（ROC） curves of sPSA、PSAD、f/tPSA、s/uPSA were made,and the area under the ROC curves were analyzed.Results：The levels of tPSA,uPSA in PCa and BPH group were approximate（P 0.05）.The value of s/uPSA and PSAD in PCa group were significantly higher than that of BPH group（P0.01 or 0.05）,while f/tPSA was lower than that of BPH group.The area under ROC curve of these indexes in descending order was s/uPSA,PSAD,f/tPSA and sPSA.Conclusion：Compared wih sPSA,the indexes such as s/uPSA,PSAD,f/tPSA are more specific to distinguish PCa from prostate diseases when sPSA is within 4～10 μg/L,and s/uPSA is the most valuable index among them.