云南白药用于降低非特异性升高PSA及早期前列腺癌筛查的作用分析  

Effect of yunnan baiyao therapy on non-specific elevated PSA and prostate biopsy

作　　者：余忠伟[1] 成康[1] 孙福康[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,上海200025

出　　处：《国际泌尿系统杂志》2017年第5期653-656,共4页International Journal of Urology and Nephrology

摘　　要：目的 探讨云南白药是否能够降低非特异性升高的患者血清PSA水平,提高前列腺穿刺结果阳性率,减少不必要的穿刺.方法 选取2012年以来因体检发现PSA升高来本院泌尿外科就诊且年龄大于50岁,4 μg/mL＜ PSA＜20 ng/mL的疑似前列腺癌男性患者96例,口服云南白药治疗6个月.门诊随访6个月检测PSA水平变化,用于评价云南白药治疗效果.6个月后根据PSA是否下降20％将患者分为PSA下降组和PSA未下降组两组,分别随机抽取PSA下降组和PSA未下降组21、29例患者进行前列腺穿刺检查,比较两组前列腺穿刺阳性率.结果 云南白药治疗l、2、3、6个月后,患者血清PSA水平下降,差异均具有统计学意义（P＜0.05）,其中服药6个月后PSA平均降低2.05 ng/mL,下降22.2％左右.PSA下降组有l例（4.76％）穿刺结果阳性;PSA未下降组有6例（20.7％）穿刺结果阳性,差异具有统计学意义（P＜0.05）.云南白药治疗后血清PSA下降20％作为前列腺癌筛选标准的灵敏度为85.71％,特异度46.51％.结论 口服云南白药可能通过降低非特异性升高的PSA水平,提高前列腺穿刺阳性率,减少不必要的穿刺.Objective To evaluate whether a six months course of Yunnan Baiyao therapy would lower serum prostate specific antigen （PSA） and affect outcome of prostate biopsy.Methods In this randomized,prospective and non-blinded clinical trial,we recruited eligible 96 asymptomatic patients who were older than 50 years old and with PSA of 4 ～20 ng/mL in our center.All patients were treated with Yunnan Baiyao for 6 months.PSA tests,digital rectal examination （DRE） and ultrasonography（US） were conducted in the following 1,2,3,6 months.Six months later,patients were divided into two groups according to their treatment response：group 1 with reduced PSA level （defined as a decrease in PSA by at least 20％） and group 2 with no response.Twenty-one and 29 patients from group 1 and group 2 were randomly assigned respectively and underwent transrectal ultrasound-guided prostate biopsy.Results The average PSA decreased significantly compared with baseline value after a course of 6 months treatment,with a change of 2.05 ng/mL,about a reduction rate of 22.2％ （P ＜0.05）.Of those who received biopsy,1 case in group 1 and 6 cases in group 2 were diagnosed with prostate cancer （4.76％ vs.20.7％,P ＜0.05）.The sensibility and specificity of PSA reduction of ≥20％ was 85.71％ and 46.51％ respectively.Conclusions Yunnan Baiyao may contribute to decline of elevated PSA caused by non-malignant lesions and improve positive prostate biopsy ratio,thereby avoiding unnecessary prostate biopsy.However,the outcome should be further validated by multicenter,large sample and long-term follow-up clinical trial.

关 键 词：前列腺肿瘤 前列腺特异抗原 云南白药 

分 类 号：R273[医药卫生—中西医结合]