血清tPSA、f/t比值及PSAD在鉴别前列腺良恶性病变中的价值

目的比较血清总前列腺特异抗原(tPSA)、游离PSA(fPSA)与tPSA的比值(f/t)、前列腺特异抗原密度(PSAD)鉴别诊断前列腺增生(BPH)和前列腺癌(P ca)的价值。方法测定150例BPH和52例P ca患者血清tPSA、fPSA浓度,计算f/t比值;经腹部B超测得前列腺体积(PV),求得PSAD值。分别比较tPSA、f/t及PSAD在诊断灰区、灰区外低值区、灰区外高值区中鉴别两种疾病的能力。结果在诊断灰区外高值区,tPSA、f/t及PSAD在两组间的差别均有统计学意义(P<0.001或P<0.05);在诊断灰区,两组患者间tPSA差别无统计学意义(P>0.5),而f/t、PSAD的差别则有统计学意义(P<0.05或P<0.001),在灰区外低值区,tPSA、f/t及PSAD在两组间的差别均无统计学意义(P>0.05)。结论血清tPSA为前列腺癌的标志物,而f/t及PSAD作为tPSA的辅助指标,在诊断灰区有重要的意义。

Total PSA,f/t Ratio and PSAD in the Differential Diagnosis of Benign and Malignant Prostatic Diseases

Objective To evaluate serum tPSA,f/t ratio and PSAD in the differential diagnosis of BPH and Pca.Methods Serum tPSA,fPSA and PV by B ultrasound scanning in 150 cases of BPH and 52 cases of Pca were assessed,f/t ratio and PSAD were obtained.Total PSA(tPSA),f/t and PSAD in patients both within and outside the gray zone were analyzed.Results Total PSA,f/t and PSAD were significantly discriminated between benign and malignant diseases(P<0.001 or P<0.05) when the assessed value were much higher beyond gray zone.When the assessed value were within the gray zone,tPSA could not serve as a differential marker for the two conditions(P>0.5) whereas f/t and PSAD could(P<0.05 or P<0.001).However,tPSA,f/t and PSAD could not specifically differentiate between the two conditions(both were P>0.05) in the lower value range beyond the gray zone.Conclusion Serum tPSA is a marker for diagnosis of prostatic carcinoma,f/t and PSAD,being an adjuvant marker to tPSA,are of importance in the differential diagnosis in patients whose B ultrasound findings are within the gray zone.