高敏C反应蛋白与前列腺癌骨转移的相关性  

The correlation between high sensitive C-reactive protein and bone metastasis of patients with newly diagnosed prostate cancer

作　　者：陈晔[1] 李纲[1] 谢赣生[1] 张学锋[1] 殷虎明 胡秦[1] 王力[1] 浦金贤[1] 侯建全[1] 

机构地区：[1]苏州大学附属第一医院泌尿外科,215006

出　　处：《中华泌尿外科杂志》2016年第10期772-776,共5页Chinese Journal of Urology

基　　金：江苏省医学重点人才基金（RC2011108）

摘　　要：目的 探讨血清高敏C反应蛋白（high sensitive C-reactive protein,hs-CRP）与初诊前列腺癌患者骨转移的相关性.方法 回顾性分析2010年1月至2015年10月收治的294例经前列腺穿刺活检初诊为前列腺癌患者的临床资料.年龄中位值70岁（65 ～ 75岁）.直肠指检阳性90例（30.6％）.前列腺体积中位值36.5 m1（25.2 ～53.1 ml）.PSA中位值32.95 ng/ml（14.49～ 82.89ng/ml）.PSAD中位值0.90 ng/（ml＆#183;cm3）[0.44～1.95 ng/（ml＆#183;cm3）].Gleason评分≤6分37例（12.6％）,7分97例（33.0％）,≥8分160例（54.4％）.临床T分期T1期94例（32.0％）,T2期132例（44.9％）,T3期50例（17.0％）,T4期18例（6.1％）.淋巴结转移29例（9.9％）.骨转移组59例（20.1％）,非骨转移组235例（79.9％）;肺转移1例（0.3％）.比较骨转移患者和非骨转移患者的hs-CRP水平差异,以及hs-CRP增高组（hs-CRP＞ 3.0 mg/L）和正常组（hs-CRP≤3.0 mg/L）患者的骨转移率.采用Logistic回归分析hs-CRP、PSA、PSAD、Gleason评分和临床T分期与初诊前列腺癌患者发生骨转移的关系.运用受试者工作特征曲线（ROC曲线）比较hs-CRP、PSA、PSAD对骨转移的诊断价值.结果 本研究294例hs-CRP 0.77～6.33 mg/L,平均1.80 mg/L.骨转移组血清hs-CRP中位值为6.90 mg/L（1.95 ～13.74 mg/L）,明显高于非骨转移组的1.43 mg/L（0.70 ～4.32mg/L）,差异有统计学意义（P＜0.05）.骨转移组与非骨转移组的PSA、Gleason评分和临床T分期比较差异均有统计学意义（P＜0.05）.hs-CRP增高组的前列腺癌患者骨转移率为37.2％（42/113）,明显高于hs-CRP正常组的9.4％ （17/181）（P＜0.05）.Logistic回归分析结果显示,hs-CRP（OR=1.149,95％ CI1.080 ～1.222,P＜0.05）、PSA（OR=1.013,95％CI1.002 ～1.023,P＜0.05）和Gleason评分（OR=2.515,95％CI1.198 ～5.279,P＜0.05）是初诊前列腺癌患者发生骨转移的独立危险因素.hs-CRP诊断初诊前列腺癌患者骨转移的ROC曲线下面积Objective To assess the correlation between high sensitive C-reactive protein and bone metastasis of patients with newly diagnosed prostate cancer.Methods From Jan.2010 to Dec.2015,a total of 294 consecutive patients with newly diagnosed prostate cancer by prostate biopsy were enrolled in this study.The median age was 70（65-75） years.There were 90（30.6％） patients with a positive DRE （digital rectal examination）.The median prostate volume,PSA and PSAD were 36.5 ml（25.2-53.1 ml）,32.95 ng/ml（14.49-82.89 ng/ml） and 0.90 ng/（ml ＆#183; cm3） [0.44-1.95 ng/（ml ＆#183; cm3）],respectively.There were 37 （12.6％） patients with a Gleason score ≤ 6,97 （33.0％） with a Gleason score of 7 and 160 （54.4％） with a Gleason score ≥ 8.Clinical stage was also evaluated,including 94（32.0％） diagnosed as T1 stage,132（44.9％） T2 stage,50（17.0％） T3 stage,and 18（6.1％） T4 stage.Regional lymph node metastases were found in 29 （9.9％） patients.All patients underwent bone scan and 59 patients showed bone metastases.One patient showed pulmonary metastases by computed tomography （CT）.The difference of hs-CRP level between patients with bone metastasis and without bone metastasis was analyzed by MannWhitney U test.The difference of bone metastasis rate between the patients with elevated hs-CRP level （hsCRP ＞3.0 mg/L） and normal hs-CRP （hs-CRP≤3.0 mg/L） level was analyzed by Chi-squared test.Logistic regression was used to evaluate the effect of hs-CRP,prostate specific antigen （PSA）,prostate specific antigen density （PSAD）,Gleason score and clinical stage on bone metastasis.Areas under operating characteristic curves （AUC） were used to compare the predictive value of hs-CRP,PSA and PSAD.Restlts The hs-CRP level of the 294 patients ranged from 0.77 mg/L to 6.33 mg/L,with a median of 1.80 mg/L.The median （interquartile range） of hs-CRP was 6.90 mg/L （1.95-13.74 mg/L） in patients with bone metastasis which is higher than 1.43 mg/L （0.7

关 键 词：高敏C反应蛋白 前列腺癌 骨转移 

分 类 号：R737.25[医药卫生—肿瘤]