血tPSA、cPSA、IGF-I联检对前列腺疾病诊断的临床价值

目的：探讨联检血清前列腺特异性抗原（tPSA）、复合前列腺特异性抗原（cPSA）、胰岛素样生长因子-I（IGF—I）含量及cPSA／tPSA比值对前列腺疾病诊断的临床价值。方法：分别采用磁微粒免疫化学发光法（ICLMA）和免疫放射分析（IRMA）对41例前列腺癌（PCa）、60例前列腺增生（BPH）患者和55例正常对照者进行tPSA、cPSA、IGF—I定量检测和计算cPSA／tPSA比值并比较分析。结果：PCa患者血清中tPSA、cPSA、IGF—I水平明显高于BPH组和正常对照组（P〈0．01）；BPH、PCa两组患者各项检测指标在“灰色区域”上分布差异有显著性（P〈0．01）；以tPSA〉4ng／ml、cPSA〉3．6ng／ml、IGF—I〉150和cPSA／tPSA〉0．74作为筛选PCa的临界值，其临床灵敏度、特异度、阳性预测值、阴性预测值分别为88．6％、84．9％、83．0％、90．0％。结论：联合使用tPSA、cPSA、cPSA／tPSA和IGF—I指标进行PCa的筛选，其临床诊断概率优于各单一指标，且对早期PCa的诊断和BPH的区别有重要的临床价值。

Clinical Diagnostic Value of Combined Determination of Serum tPSA, cPSA and IGF-I Levels in Patients with Prostatic Disorders

Objective To investigate the diagnostic value of combined determination of serum total prostatic specific antigen (tPSA), complex prostatic specific antigen (cPSA) and IGF-I levels in patients with prostatic disorders. Methods Serum tPSA, cPSA (with CLIA) and IGF-I (with IRMA) levels were determined in 41 patients with prostatic carcinoma, 60 patients with benign prostatic hypertrophy (BPH) and 55 controls. Results The serum tPSA, cPSA and IGF-I levels in patients with prostatic cancer were significantly higher than those in patients with BPH and controls (P<0.01). Taking the cut-off values of 4ng/ml, 3.6ng/ml and 150 for tPSA, cPSA and IGF-I respectively, the combined determination of these three items would yield a sensitivity of 88.6%, specificity of 84.9%, positive predicative value of 83% and negative predicative value of 90.0% for diagnosis of prostatic cancer. Conclusion Combined determination of tPSA, cPSA and IGF-I would yield better sensitive and accurate diagnostic rate in patients with prostatic cancer, especially in those with laboratory values within the "grey zone".