前列腺特异性抗原与前列腺结节增生病理类型的关系  

Use of prostate-specific antigen to predict pathologic types in nodular benign prostate hyperpiasia

作　　者：李贵忠[1] 刘流[1] 黄广林[1] 王建伟[1] 刘宁[1] 满立波[1] 何峰[1] 王海[1] 袁亦铭[2] 杨新宇[2] 夏同礼[2] 那彦群[2] 

机构地区：[1]北京积水潭医院泌尿外科,100035 [2]北京大学第一医院泌尿外科北京大学泌尿外科研究所

出　　处：《中华泌尿外科杂志》2006年第11期752-754,共3页Chinese Journal of Urology

摘　　要：目的探讨前列腺特异性抗原(PSA)与前列腺结节增生病理类型的关系。方法对210例经临床和病理确诊为良性前列腺增生(BPH)的患者资料作回顾性研究。结果本组间质结节18例(9％)、腺肌性结节59例(28％)、纤维腺瘤性结节12例(6％)、腺性结节39例(19％)、混合结节82例(39％)。5组间总PSA(tPSA)、游离PSA(fPSA)差异均有统计学意义(P<0．05),而％fPSA差异无统计学意义(P>0．05)。若按腺体增生为主和间质增生为主两类比较,tPSA和fPSA差异有统计学意义(P<0．05),％fPSA差异无统计学意义(P>0．05)。多元线性回归分析发现,tPSA是5种病理结节类型最相关的指标,通过ROC曲线(受试者工作曲线)确定敏感指标的界值tPSA≥2．5 ng／ml,敏感性为96％,特异性为20％,ROC曲线下面积为0．61,如果组合fPSA≥0．5 ng／ml和tPSA≥2．5 ng／ml,敏感性为100％,特异性为67％,ROC曲线下面积为0．91(P<0．001)。结论组合tPSA与fPSA可提示前列腺结节增生病理类型,对临床药物选择具有指导意义。Objective To determine the value of clinical testing of prostate-specific antigen （PSA） to predict pathologic types in nodular benign prostate hyperplasia （ BPH）. Methods The data of 210 consecutive patients with clinically and pathologically proven BPH were retrospectively analyzed. Results According to histopathologic findings,stromal nodule,acinar smooth muscle nodule, fiber acinar nodule, acinar nodule and mixed nodule were found in 18 cases（9%）,59（28%）,12 （6%）,39 （19%） and 82 （39%） ,respectively. The differences in total PSA （tPSA） and free PSA （fPSA） levels were significant among the 5 groups of BPH types （P 〈 0.05） ;while the difference in percentage of fPSA was not significant （ P 〉 0.05 ）. There were significant differences of tPSA and fPSA between histologic types （ primarily glandular or stromal hyperplasia） in BPH （ P 〈 0.05 ） , but no significant difference in percentage of fPSA （ P 〉 0.05）. In multivariate analysis, tPSA was the only significant predictors of pathologic types of nodules in BPH. A model was constructed to predict pathologic types in BPH. If tPSA 〉I 2.5 ng/ml （ cut-off value of sensitivity） ,the sensitivity,specificity and area under ROC Curve were 96% ,20% and 0.61 ,respectively. If tPSA〉μ2.5 ng/ml combined with fPSA I〉0.5 ng/ml,the sensitivity, specificity and area under ROC Curve were 100% ,67% and 0.91 ,respectively （P 〈 0. 001 ）. Conclusions The combination of tPSA and fPSA provides the best prediction of pathologic types in BPH. Treatment regimens based on this combination of factors may be clinically useful to stratify patients for drug options.

关 键 词：良性前列腺增生 病理学 前列腺特异性抗原 活检 

分 类 号：R697.3[医药卫生—泌尿科学]