前列腺被膜支血管阻力指数测定在前列腺癌的诊断价值

目的探讨前列腺被膜支血管阻力指数(RI)与前列腺癌(PCa)的关系。方法利用彩色多普勒超声检测87例前列腺穿刺活检患者的前列腺被膜支血管RI,并行前列腺穿刺组织活检。分析前列腺被膜支血管RI在PCa中的诊断价值,并与血清总前列腺特异性抗原(tPSA)、游离/总前列腺特异性抗原(f/tPSA)及前列腺特异性抗原密度(PSAD)的诊断价值比较。运用受试者工作特性(ROC)曲线,确定前列腺被膜支血管RI最佳临界点。结果 87例前列腺穿刺活检患者中,良性前列腺增生(BPH)56例(64.4%),PCa 31例(35.6%)。与BPH相比,PCa的前列腺被膜支血管RI明显升高(0.72±0.10vs.0.78±0.10)P<0.05)。tPSA、f/tPSA、PSAD在PCa和BPH患者之间均有统计学差异(P<0.05)。但在灰区(tPSA为4-10ng/ml)患者中,仅前列腺被膜支血管RI和PSAD存在统计学差异(P<0.05)。ROC曲线确定前列腺被膜支血管RI诊断PCa最佳临界点为0.72,当RI≥0.72系列联合PSAD>0.15ng.ml-1.cm-3时,诊断PCa的敏感度77.4%、特异度78.6%。结论测定前列腺被膜支血管RI对鉴别PCa与BPH有着重要临床应用价值,尤其当tPSA处于灰区时。前列腺被膜支血管RI联合PSAD在诊断PCa时有较好的敏感度和特异度。

Role of resistance index of prostatic capsular artery in diagnosis of prostate cancer

Objective To investigate the relationship between resistance index(RI) of prostate capsular artery and prostate cancer(PCa).Methods The RI of prostatic capsular artery was measured in 87 patients undergoing transrectal ultrasound-guided needle prostate biopsy.The results were analyzed with those of total proastate specific antigen(tPSA),free/total PSA(f/tPSA) and proastate specific antigen density(PSAD).The cutoff value of RI for diagnosing PCa was determined by ROC curve.Results Of 81 cases,31 patients were diagnosed as PCa and 56 cases were with benign prostatic hyperplasia(BPH).The RI of prostatic capsular artery was higher in PCa patients than that in BPH patients(0.78±0.10 vs.0.72±0.10)P<0.05).The values of tPSA,f/tPSA and PSAD were also significantly different between PCa and BPH patients(P<0.05).However,higher RI and PSAD were found only in PCa patients among those with gray PSA value(4-10 ng/ml)(P<0.05).The best cutoff value determined by ROC curve to diagnose PCa was 0.72.The sensitivity and specificity for diagnosing PCa were 77.4% and 78.6%,respectively,when two cutoff values of RI≥0.72 and PSAD>0.15 ng·ml-1·cm-3 were serially combined.Conclusion RI of prostatic capsular artery might have significant clinical value in differentiating PCa from BPH among the patients underwent needle prostate biopsy,especially among those with PSA gray value.The relative high sensitivity and specitivity of diagnosing PCa could be achieved by serially combined detecting RI of prostatic capsular artery and PSAD.