前列腺特异性抗原异常患者前列腺液细胞学检查的临床分析  

Analysis of prostatic fluid cytology in patients with elevated PSA

作　　者：陈鑫[1] 李宇峰[1] 王萍[2] 岳东民[1] 叶青[1] 杨卓[1] 臧伟清[1] 王广浩[1] 曲晓光[1] 高福金[1] 

机构地区：[1]吉林市中心医院泌尿外科,132000 [2]吉林市儿童医院内科

出　　处：《中华泌尿外科杂志》2012年第2期123-126,共4页Chinese Journal of Urology

摘　　要：目的研究PSA值增高患者前列腺液脱落细胞学检查诊断前列腺癌的临床分析及前列腺液中自细胞状态对血清PSA的影响。方法130例PSA值增高患者在行经直肠前列腺穿刺活检前，行直肠指检按摩获取前列腺液，进行瑞氏染色和脱落细胞学分级，并行前列腺液中的白细胞计数。方差分析PSA水平在不同脱落细胞学分级之间的差异，采用Spearman相关分析检验前列腺液体积、白细胞密度和白细胞总数与患者的tPSA、fPSA、年龄、前列腺体积的相关性，行t检验或Wilcoxon秩和检验比较前列腺癌和非前列腺癌组tPSA、fPSA、年龄、前列腺液体积、前列腺液中的白细胞密度、白细胞总数、前列腺体积的差异。结果病理学结果显示前列腺癌77例（59．2％），非前列腺癌53例（40．8％）。脱落细胞分级I～V级分别为28例（21．5％），32例（24．6％），22例（16．9％），36例（27．7％），12例（9．2％）。脱落细胞学检查特异性为100％。在PSA≥20斗g／L的患者中，具有较高的敏感性（10／16，62．5％）。在脱落细胞学分级I～Ⅳ级之间PSA值差异无统计学意义（P〉0．05），I～Ⅳ级与V级之间PSA值比较差异有统计学意义（P〈0．05）。前列腺液体积和白细胞总数与前列腺体积呈显著性相关，非前列腺癌患者的前列腺体积、白细胞密度和总数显著高于前列腺癌患者，且其血清PSA值与前列腺液中的白细胞密度呈正相关性。结论PSA值增高患者行前列腺液脱落细胞学检查诊断前列腺癌是一种有效的方法，尤其在患者PSA值较高时。非前列腺癌患者的PSA值增高可能与前列腺液中的白细胞增高有关。Objective To study the value of the exfoliativc cytology of prostatic fluid obtained from patients with elevated PSA in prostate cancer diagnosis. Methods Prostatic fluid was obtained from 130 patients with elevated PSA before prostate biopsy and then the Wright＇s stain and cytological class were done. Each cytological class and patient＇s age, PSA, total prostate volume, prostatic fluid volume and the number of leukocyte in the prostatic fluid were recorded. The relationship of leukocyte number and patient＇s age, PSA and prostate volume was analyzed by Spearman correlation test. Results Prostate biopsy pathology results showed that there were 77 （59.2%） cancer cases and 53 （40.8%） non-cancer cases. Patient numbers in cytological class 1 to5 were 28 （21.5%）, 32 （24.6%）, 22 （16.9%）, 36 （27.7%）, 12 （9.2%） , respectively. The prostate fluid cytology had a specificity of 100% and high sensitivity of 62.5% （10/16） in patients with PSA≥20μg/L. PSA value had significant difference between class 1, 2, 3, 4 and 5. Significant correlation was found among the prostatic fluid volume, total leukocyte number and prostate volume. Prostate volume, leukycyte density and total leukyeyte number was significant higher in noncancer patients than in prostate cancer patients. Conclusions The exfoliative cytology of prostatic fluid is a valuable method in detecting prostate cancer, particularly in patients with high PSA levels. It has the advantages of non-invasion and less injury than prostate biopsy. There is a relationship between elevated PSA value and high leukocyte numbers.

关 键 词：前列腺特异抗原 前列腺液 前列腺肿瘤 细胞诊断学 白细胞 

分 类 号：R737.25[医药卫生—肿瘤]