血清前列腺健康指数对 tPSA灰区前列腺癌患者的诊断价值探讨

目的　探讨前列腺健康指数（PHI）在血清总前列腺特应性抗原（tPSA）灰区（4~10 ng/ml）前列腺癌（PCa）患者中的诊断价值。方法　选择 2018年 3月～ 2019年 10月上海市金山区亭林医院泌尿外科收治的 94例血清 tPSA在 4～ 10 ng/ml的老年男性患者临床资料。其中 PCa组 21例，前列腺良性增生（ BPH）73例。检测两组患者血清中 tPSA、游离 PSA（fPSA）以及前列腺特异性抗原前体 2型（p2PSA）的指标水平，从而计算得出 fPSA/tPSA比值和 PHI，并绘制 tPSA, fPSA/tPSA, p2PSA以及 PHI的受试者工作特征（ ROC）曲线，得出曲线下面积（ AUC）、95%CI以及截断值（ cut off value），分析 tPSA, fPSA/tPSA, p2PSA以及 PHI的检测对 PCa患者的早期诊断价值。结果　两组患者的血清 tPSA,fPSA和p2PSA水平差异均无统计学意义（U=899，450和 261.5，均 P >0.05）；两组患者 fPSA/tPSA（U=261.5， P =0.023）与 PHI（t=1275.5，P<0.001）指标的差异有统计学意义（均 P <0.05）。tPSA, fPSA/tPSA, p2PSA以及 PHI的 ROC曲线下面积分别为 0.586，0.676，0.613和 0.832，其中 tPSA, fPSA/tPSA和 p2PSA（AUC值均 <0.7）的诊断效能较低，而 PHI的诊断效能较高。血清 PHI的准确度（ 81.9%）明显高于 tPSA, fPSA/tPSA和 p2PSA，差异有统计学意义（ χ2=6.975， 4.145和 6.211, 均 P <0.05）。tPSA及 p2PSA指标对提高 PCa的诊断效率无明显助益（均 P >0.05），fPSA/tPSA和 PHI明显提高 Pca的诊断效力（ P<0.05），其中 PHI的诊断效果最佳（ P<0.001），PHI的 AUC值 0.832（95% CI: 0.733～ 0.931）高于 fPSA/tPSA的 AUC值 0.676（95% CI: 0.539～ 0.812），差异有统计学意义（Z=2.758，P<0.01）。结论　PHI诊断 tPSA灰区 PCa患者的诊断效能与准确性均较高，具有比 tPSA, fPSA/tPSA和 p2PSA更高的诊断价值。

Diagnostic Value of Serum Prostate Health Index in Prostate Cancer Patients with PSA Gray Area

Objective To investigate the diagnostic value of prostate health index(PHI)in prostate cancer(PCa)patients with serum tPSA gray area(4~10 ng/ml).Methods The clinical data of 94 elderly male patients with tPSA at 4~10 ng/ml diagnosed by prostate biopsy from March 2018 to Octorber 2019 were selected.There were 21 cases of prostate cancer(PCa)and 73 cases of benign prostatic hyperplasia(BPH).The index levels of tPSA,fPSA and p2PSA were detected,and the ratio of fPSA/tPSA and PHI were calculated.The receiver operating characteristic(ROC)curves of tPSA,fPSA/tPSA,p2PSA and PHI were drawn.The area under the curve(AUC),95%CI and cut-off value were obtained.The early diagnostic values of tPSA,fPSA/tPSA,p2PSA and PHI in patients with PCa were analyzed.Results There were no significant differences in age,serum tPSA,fPSA and p2PSA levels between PCA group and BPH group(U=899,450 and 261.5,all P>0.05)and there were significant differences in fPSA/tPSA(t=2.103,P=0.041)and PHI(t=3.560,P<0.001)between the two groups(P<0.05).The area under ROC curve of tPSA,fPSA/tPSA,p2PSA and PHI were 0.586,0.676,0.613 and 0.832,respectively.Diagnostic efficacy of tPSA,fPSA/tPSA,p2PSA(AUC values<0.7)were lower than those of PHI.The accuracy of serum PHI(81.9%)was significantly higher than that of tPSA,fPSA/tPSA and p2PSA(χ^2=6.975,4.145 and 6.211,all P<0.05).tPSA and p2PSA had no significantly improvementfor the diagnostic efficacy of PCa(P>0.05),fPSA/tPSA and PHI significantly improved the diagnostic efficacy of PCa(P<0.05),and PHI had the best diagnostic efficacy(P<0.001).The AUC value of PHI 0.832(95%CI:0.733~0.931)which was higher than that of fPSA/tPSA 0.676(95%CI:0.539-0.812),and the difference was statistically significant(z=2.758,P<0.01).Conclusion PHI can be used as a tumor screening index for the diagnosis of prostate cancer patients with serum tPSA gray area.It has higher diagnostic accuracy and value than tPSA,fPSA/tPSA,p2PSA.