外周血与尿PCA3基因表达和尿PCA3评分在前列腺癌诊断中的意义  

Gene expression of PCA3 in peripheral blood and urine and the significance of urine PCA3 score in diagnosis of prostate cancer

作　　者：刘龙亚 温端改[2] 何军[3] 侯健全[2] 岑建农[3] 浦金贤[2] 

机构地区：[1]湘西土家族苗族自治州人民医院泌尿外科,湖南省吉首市416000 [2]苏州大学附属第一医院泌尿外科 [3]苏州大学附属第一医院江苏省血液研究所

出　　处：《中华泌尿外科杂志》2012年第4期278-281,共4页Chinese Journal of Urology

基　　金：江苏省卫生厅科技发展项目（H200714）;教育部博士点基金（200802850014）

摘　　要：目的 探讨外周血、尿液中PCA3和PSA基因表达在前列腺癌诊断中的应用价值。方法2009年6月至12月因前列腺疾病住院患者105例，收集前列腺按摩后的初始尿液和外周血标本，经病理证实前列腺癌37例、BPH68例；8例泌尿系结石患者作为正常对照。应用实时定量PCR检测尿沉渣、外周血单个核细胞中PCA3、PSAmRNA表达，以Bactin为内参照。结果外周血PCA3的mRNA表达敏感性为48．6％，特异性为100％。尿PCA3评分经ROC曲线分析，ROC—AUC=0．908，以截断值64．6为诊断前列腺癌的临界值，前列腺癌患者中尿PCA3阳性率为81．1％，BPH患者中尿PCA3阴性率为86．8％。5例血清tPSA〈4μg／L前列腺癌患者，尿PCA3评分诊断前列腺癌4例；3例血清tPSA4～10I．zg／L前列腺癌患者，尿PCA3评分诊断前列腺癌2例；29例血清tPSA〉10Ixg／L前列腺癌患者，尿PCA3评分诊断前列腺癌24例（82．8％）。22例血清tPSA〈4Ixg／LBPH者，PCA3评分诊断阴性率为89．4％（20／22）；19例血清tPSA4～10μg／LBPH者中，PCA3评分诊断阴性率为84．2％（16／19）；27例血清tPSA〉10Ixg／LBPH者中，PCA3评分诊断阴性率为81．5％（22／27）。尿PCA3评分、外周血PCA3联合检测的敏感性为86．5％，高于两者单独测定。结论外周血中的PCA3mRNA表达是诊断前列腺癌的特异性指标，尿PCA3评分联合检测外周血中PCA3基因表达可以提高前列腺癌的诊断敏感性。Objective To detect the gene expression of PCA3 and PSA in peripheral blood and une simultaneously to investigate whether PCA3 combining PSA gene could become new markers for diagnosis of Pca. Methods From June 2009 to December 2009, the initial urine after prostatic massage and the peripheral blood specimens were collected from 37 patients with PCa and 68 patients with BPH that were pathologically confirmed, 8 patients with urinary stone were used as normal control, the expression of PCA3 and PSA mRNA of mononuclear cells in urine sediments and peripheral blood were detected by fluorescence real-time quantitative PCR, with β-actin mRNA as internal control. Results The sensitivity and specificity of the expression of PCA3 mRNA in peripheral blood for diagnosis of prostate cancer were 48.6% and 100% respectively. ROC curve analysis was performed for the PCA3 score and the area under the ROC curve was 0. 908. Using 64.6 as the cutoff, the sensitivity was 81.1% and the specificity was 86.8%. In group with serum tPSA value 〈 4μg/L, the positive rate and negative rate of urinary PCA3 score for diagnosing prostate cancer were 80% （4/5） and 89.4% （20/22） respectively. In group with serum tPSA value 4 - 10μg/L, the positive rate and negative rate of urinary PCA3 score were 66.7% （2/3） and 84.2% （16/19） respectively. In group with serum tPSA value 〉 10 μg/L, the positive rate and negative rate of urinary PCA3 score were 82.8% （24/27） and 81.5% （22/27） respectively. The sensitivity of simultaneous detection of PCA3 mRNA in peripheral blood and urinary PCA3 score was 86.5%. Conclusions The expression of PCA3 mRNA in peripheral blood was a specific marker for the diagnosis of PCa. The simultaneous detection of PCA3 mRNA in peripheral blood and urinary PCA3 score could increase the sensitivity for the diagnosis of PCa.

关 键 词：前列腺癌基因3 前列腺特异抗原基因 尿前列腺癌基因3评分 前列腺癌 实时定量聚合酶链反应 

分 类 号：R737.25[医药卫生—肿瘤]