前列腺液中DD3mRNA定量检测无侵入性诊断前列腺癌的意义  

Significance of non-invasive diagnosis of prostate cancer by quantitative-detection of DD3mRNA in prostatic fluid

作　　者：陈海文[1] 甘为民[1] 张楠[1] 王子明[1] 陈琦[1] 李洪亮[1] 

机构地区：[1]西安交通大学医学院第二附属医院泌尿外科,陕西西安710004

出　　处：《西部医学》2013年第2期180-184,187,共6页Medical Journal of West China

基　　金：西安市科技发展引导计划资助项目(SF08006)

摘　　要：目的探讨前列腺按摩后前列腺液沉渣中DD3mRNA含量在前列腺癌诊断中的应用价值。方法在前列腺穿刺活检前或术前麻醉后收集前列腺按摩后患者的前列腺液。其中前列腺癌(Pca)患者31例,前列腺增生患者(BPH)59例,离心取细胞沉淀物,用荧光实时定量逆转录-聚合酶链反应(Real time RT-PCR)方法检测DD3mRNA和PSAmRNA含量,以PSAmRNA作为管家基因校正前列腺液沉渣中的前列腺细胞,以DD3mRNA/PSAmRNA比值表示DD3mRNA含量。SPSS 13.0分析相关数据,以穿刺活检或术后病理检查结果为金标准,用受试者工作特征曲线(ROC)对DD3mRNA诊断性能进行分析,并与血清tPSA进行比较,同时探讨前列腺液DD3mRNA相对定量值阳性率与病理分级的关系。结果前列腺癌患者前列腺液DD3mRNA表达量明显高于BPH,差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,曲线下面积(ROC-AUC)=0.879(95%CI=0.795～0.964)。DD3mRNA相对定量值截断值取0.015313时,其诊断效能最大。其灵敏度为0.806,特异度为0.864,准确性0.67,阳性预测值75.8%,阴性预测值89.5%,阳性似然比、阴性似然比分别为5.97、0.224。若血清tPSA分别以4ng/ml和10ng/ml为截断值时,灵敏度分别为83.8%和54.84%,特异度分别为61.02%和83.05%,不同病理分级之间DD3mRNA的阳性率差异无统计学意义(P>0.05)。结论前列腺液中DD3mRNA测定的诊断性能明显高于血清PSA,作为前列腺癌的一种非损伤性诊断方法具有良好的应用前景。Objective To study the expressions of differential display code 3 mRNA （DD3 mRNA） in the prostatic fluid samples of patients with prostate cancer and its diagnostic value in prostate cancer. Methods The prostatic fluid samples were collected before biopsy or operation, including 31 benign prostatic hyperplasia and 59 prostate cancer patients; the total RNA had been extracted for Real time RT-Polymerase chain reaction; agarose gel electrophoresis were applied to confirm PCR product of DD3 using PSA as house-keeping gene, the semi-determination of DD3 mRNA were carried out simultaneously. PSA was used as a house-keeping gene to normalize the number of prostate cells and then DD3 mRNA/ PSA mRNA ratio was used as a diagnostic tool. Fluorescent quantitation polymerase chain reaction was applied to relative quantitative determination of DD3 mRNA. The ROC curve was used to evaluate the diagnostic efficacy of DD3 mRNA in prostatic fluid samples and compared with serum PSA. Expression of DD3 mRNA among different clinic pathologic grades was also analysed. SPSS13.0 were used for data analysis. Results There was significant difference of DD3 mRNA expression in prostatic fluid sediment between BPH and PCa patients （P〈0.01）. Applied receive operative characteristic curve analysis data, the area under the curve of tPSA, relative quantitation value of DD3 mRNA are 0. 782, 0. 879 respectively. At cutoff of 0. 015313, the efficacy of relative quantitation value of DD3 mRNA is maximal. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio for DD3 mRNA were 0. 806, 0. 864, 0.67, 75.8%, 89.5%, 5.97 and 0. 224 respectively. The sensitivity and specificity for DD3 mRNA positive rate were 77.42%, 94.91%, the sensitivity were 83.8% and 54.84% and the specificity were 61.02; and 83.05; at serum tPSA cutoff value 4ng/ml and 10ng/ml respectively. DD3 mRNA positive rate has no significant difference between Gleason grades（P〈0. 05）

关 键 词：DD3mRNA 实时荧光定量RT-PCR 前列腺癌 前列腺液 

分 类 号：R697.3[医药卫生—泌尿科学]