Ⅳ型前列腺炎与前列腺特异性抗原的关系

目的 探讨Ⅳ型前列腺炎与前列腺特异性抗原(PSA)的关系. 方法回顾性分析245例前列腺疾病患者的临床病理资料,患者平均年龄68(32～87)岁,均无前列腺癌和穿刺活检史,均行PSA、全身骨扫描、磁共振成像(MRI)和前列腺穿刺活检.结果 245例经病理证实为良性前列腺增生(BPH)118例(48%)、BPH合并Ⅳ型前列腺炎(CP)127例(52%).BPH组患者f-PSA、t-PSA、f/t-PSA平均值分别为(1.70±1.70)、(9.40±8.10)ng/ml和0.19±0.09;合并CP组平均值分别为(2.83±4.37)、(16.87±20.51)ng/ml和0.20±0.14,2组比较差异有统计学意义(P＜0.05).多元线性回归分析结果显示t-PSA(P＜0.001)、f-PSA(P=0.003)和f/t-PSA(P=0.04)是BPH和CP最相关的指标.通过ROC曲线确定上述敏感指标的界值,以f-PSA≥0.85为界值诊断Ⅳ型前列腺炎的敏感度为77%,特异度为25%,ROC曲线下面积为0.60(P=0.014);t-PSA≥4.00 ng/ml为界值诊断Ⅳ型前列腺炎的敏感度为94%,特异度为20%,ROC曲线下面积为0.65(P=0.014);f/t-PSA≤0.16为界值诊断Ⅳ型前列腺炎的敏感度为56%,特异度为64%,ROC曲线下面积为0.61(P=0.003).结论 Ⅳ型前列腺炎是PSA升高的原因之一,以血清PSA作为前列腺癌的筛选指标时,应充分考虑前列腺炎的影响.对前列腺活检标本的病理报告,应包括对前列腺炎症的详细描述.

Relationship between serum prostate specific antigen and asymptomatic prostatic inflammation

Objective To discuss the relationship between asymptomatic prostatic inflammation (NIH category Ⅳ prostatitis)and serum prostate specific antigen. Methods In a retrospective study,245 prostate biopsies with benign pathological results from January 1998 to January 2000 were reviewed and the corresponding serum PSA before biopsy were analyzed.All patients were taken 6 or 13 cores prostate biopsy. Results One hundred and twenty-seven NIH-Ⅳ prostatitis and 118 patients with benign prostatic hyperplasia(BPH)were identified.The difference in free-PSA,totalPSA,f/t-PSA levels between BPH and NIH-Ⅳ prostatitis was significant(P＜0.05).In multivariate analysis,free-PSA,total-PSA,f/t-PSA was the significant predictors of histology in NIH-Ⅳ prostatitis(P＜0.05).The best prediction factors were constructed to predict pathology type in NIH-Ⅳ prostatitis:TPSA≥4 ng/ml,fPSA≥0.85 ng/ml and f/t-PSA≤0.16(P＜0.05). Conclusions Asymptomatic inflammation of the prostate was one of the confounding factors in patients with an elevated PSA.In the diagnosis of prostate diseases,it should be taken into account prostatitis might elevate the level of PSA.