前列腺被膜支动脉阻力指数在前列腺癌预测或筛查中的临床价值

目的通过对前列腺被膜支动脉阻力指数（RI）与血清总前列腺特异性抗原（TPSA）浓度、fPSA/tPSA比值及前列腺特异性抗原密度（PSAD）的比较研究，以探讨前列腺被膜支动脉RI在前列腺癌预测或筛查中的临床价值。 方法选取2012年1月至2016年10月在江苏省常熟市第二人民医院就诊的前列腺病患者203例。应用彩色多普勒超声分别行被膜支动脉RI、血清TPSA浓度、fPSA/tPSA比值及PSAD检测，并将患者分为前列腺癌组（118例）与前列腺增生组（85例），建立ROC曲线，计算曲线下面积。前列腺癌组与对照组RI、f/t、PSAD测值比较，采用t检验。 结果血清TPSA浓度4~10 ng/ml（灰区）患者共34例，占总数的16.75%，其余患者均在灰区之外。ROC曲线分析显示：前列腺被膜支动脉RI曲线下面积为0.77与TPSA、PSAD的0.84、0.86相接近，三者对前列腺癌的预测或筛查价值相同，而fPSA/tPSA比值AUC仅0.49。灰区内fPSA/tPSA比值、PSAD的平均值在2组间比较，差异均有统计学意义（t=2.78、3.94，P均<0.01），但在灰区外高值区fPSA/tPSA比值，差异无统计学意义（P>0.05）；而前列腺被膜支动脉RI的平均值无论是在灰区还是在灰区外高值区2组间比较，差异均有统计学意义（t=4.56、5.10，P均<0.001）。 结论单项前列腺被膜支动脉RI因数据恒定能准确地用于前列腺癌预测或筛查，其不受灰区内外的影响，在临床上有较高的应用价值。

Value of the resistance index of prostatic capsular artery in screening prostate cancer

ObjectiveTo explore the clinical value of resistance index (RI) of prostatic capsular artery in predicting or screening of prostate cancer (PCa) by comparing prostatic capsular artery RI with the serum total prostatic specific antigen (TPSA), fPSA/tPSA ratio and prostatic specific antigen dernsity (PSAD). MethodsRI of prostate capsular artery, serum TPSA, of fPSA/tPSA ratio and PSAD were measured with colour Doppler ultrasonography in this subset of 203 patients who had undergone transrectal ultrasound guided prostate puncture biopsy. The patients were divided into two groups PCa and benign prostatic hyperplasia (BPH) group] for comparative study. ResultsOf them, the level of TPSA were between 4 and 10 ng/ml (grey area) in 34 cases, accounts for 16.75% of the total subjects. All the others were outside the grey area. ROC curve analysis showed that the area under the curve (AUC) of RI of the capsular artery was 0.77, which was close to 0.84 and 0.86 of TPSA and PSAD. It indicated a similar value in predicting or screening PCa; while the AUC of fPSA/tPSA ratio was only 0.49, which had little clinical value. The fPSA/tPSA ratio and the mean value of PSAD in the grey area had significant differences (t=2.78, 3.94, P<0.02) between the two groups. However, the fPSA/tPSA ratio had no statistical significance in the high value area outside the grey area (t=0.873, P>0.05). And the mean value of RI of prostatic capsular artery had significant differences between the two groups both in the grey area and in the high value area outside the grey area (t=4.56, 5.10, P<0.001). ConclusionsRI of prostatic capsular artery can be steadily used to predict or screen PCa. It is not affected by the gray area of TPSA and is of great value in clinical practice.