COX-2、Ki-67联合检测对良恶性前列腺病变鉴别诊断的价值分析

目的 探讨环氧合酶-2(COX-2)、细胞增殖核抗原Ki-67(Ki-67)联合检测对良恶性前列腺病变的鉴别诊断价值。方法 选取2017年1月至2019年6月本院收治的168例良恶性前列腺病变患者，将其中83例前列腺癌(PCa)患者设为PCa组，85例良性前列腺病变患者良性前列腺增生（BPH）患者40例、前列腺上皮内瘤(PIN)患者45例]设为BPH+PIN组。检测两组前列腺病变组织的COX-2、Ki-67表达水平；分析前列腺组织中的COX-2、Ki-67表达水平与PCa临床病理特征的关系；采用受试者工作特征（ROC）曲线评价前列腺病变组织COX-2、Ki-67 mRNA表达水平对PCa的诊断和鉴别价值。结果 PCa组患者的前列腺组织中COX-2、Ki-67 mRNA及蛋白阳性表达率水平均高于BPH+PIN组（均P<0.001）；PCa组患者的前列腺组织中COX-2、Ki-67表达水平与临床分期、远处转移、淋巴结转移、浸润深度、分化程度有明显相关性（均P<0.05），与年龄、组织类型无相关性（均P>0.05）；前列腺病变组织的COX-2、Ki-67 mRNA诊断PCa的曲线下面积（AUC）分别为0.885、0.868，灵敏度分别为83.13%、78.31%，特异度分别为91.76%、92.94%；两者联合鉴别PCa的灵敏度（95.18%）高于两项单独检测，而特异度（90.59%）低于两项单独检测。结论 前列腺病变组织中的COX-2联合Ki-67对PCa具有较高的诊断价值，可提高诊断灵敏度，且具有较高准确度，有助于临床鉴别良恶性前列腺病变。

Value of combined detection of COX-2 and Ki-67 in differential diagnosis of benign and malignant prostatic lesions

Objective To explore the value of combined detection of cyclooxygenase-2 (COX-2) and proliferating cell nuclear antigen Ki-67 (Ki-67) in the differential diagnosis of benign and malignant prostatic lesions.Methods The clinical data of 168 patients with benign and malignant prostate diseases admitted to our hospital from January 2017 to June 2019 were selected, including 83 patients with prostate cancer (PCa) in PCa group.Patients with benign prostatic disease benign prostatic huperplasia(BPH) 40 patients, prostate intraepithelial tumor (PIN) 45 patients]were BPH+PIN group (85 patients). The expression levels of COX-2 and Ki-67 in prostate lesion tissues of the two groups were detected. The relationship between the expression levels of COX-2 and Ki-67 in prostate tissue and the clinicopathological features of PCa was analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic and differential value of COX-2 and Ki-67 mRNA expression levels in PCa.Results The expression levels of COX-2 and Ki-67 mRNA and the positive expression rates of COX-2 and Ki-67 protein in PCa group were significantly higher than those in BPH+PIN group (all P<0.001); the expression levels of COX-2 and Ki-67 in the prostate tissue of PCa group were significantly related to clinical stage, distant metastasis, lymph node metastasis, depth of invasion, and degree of differentiation（all P<0.05）; the area under the curve (AUC) of COX-2 and Ki-67 mRNA in prostate lesions was 0.885 and 0.868, the cut off value was 1.48 and 1.37, the sensitivity was 83.13%, 78.31%, and the specificity was 91.76% and 92.94%, respectively; the sensitivity (95.18%)of the combined detection for PCa were higher than those of the single detection, but the specificity (90.59%) was slightly lower.Conclusions COX-2 combined with Ki-67 has high diagnostic value for PCa, and it can significantly improve the sensitivity and accuracy, which is helpful for the clinical differentiation of benign and malignant prostatic lesions.