探讨血清tPSA、fPSA及其比值在淮安地区进行前列腺疾病筛查以及前列腺癌鉴别的合理运用  

Study of Rational Usage of tPSA,fPSA and fPSA/tPSA Ratio on the Screening of Prostate Disease and Diagnosing of Prostate Cancer in Huai'an Area

作　　者：王志粉 王书中[1] 杨士军[1] 傅广波[2] 郑云会[1] 张金华[1] WANG Zhi- fen, WANG Shu- zhong, YANG Shi-jun, FU Guang- bo, ZHENG Yun- hui, ZHANG Jin- hua(Huai＇an First People＇s Hospital, Nanjing Medical University, Huai＇ an 223300, Chin)

机构地区：[1]南京医科大学附属淮安第一医院核医学科,江苏淮安223300 [2]南京医科大学附属淮安第一医院泌尿外科,江苏淮安223300

出　　处：《标记免疫分析与临床》2018年第3期329-332,共4页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探讨血清总前列腺特异性抗原(total prostatic specific antigen,t PSA)、游离前列腺特异性抗原(free prostatic specific antigen,f PSA)及其比值(%f PSA)在淮安地区对前列腺良恶性疾病筛查及诊断的合理使用方案。方法应用电化学发光法(electrochemiluminescence,ECLIA)对160例病理确诊的前列腺增生、160例前列腺癌患者治疗前以及160例健康体检者的血清t PSA及f PSA进行检测,计算%f PSA比值并进行统计分析。结果 t PSA、f PSA及%f PSA各组中位数及四分位值分别为,前列腺癌组:54.48(13.69~100.00)μg/L,5.50(1.67~17.27)μg/L,及0.16(0.11~0.28),前列腺增生组:6.50(2.73~11.37)μg/L,0.88(0.45~1.59)μg/L,0.16(0.10~0.22)及对照组:1.45(0.5~2.6)μg/L,0.35(0.19~0.76)μg/L、0.34(0.19~0.66)。其中前列腺癌组与对照组t PSA、f PSA及%f PSA比较,前列腺癌组与增生组t PSA、f PSA比较差异有统计学意义(P均<0.05);针对三组整体结果进行ROC分析,三项指标的曲线下面积分别为:AUC(t PSA)=0.938,AUC(f PSA)=0.941,AUC(%f PSA)=0.733,单独检测t PSA或f PSA对前列腺疾病的筛查具备良好的检测效果。而对t PSA介于4~10μg/L的85例前列腺增生和38例前列腺癌进行三项指标的ROC分析,AUC(t PSA)=0.569,AUC(f PSA)=0.712,AUC(%f PSA)=0.855,提示对t PSA灰区结果,%f PSA对前列腺癌的鉴别有明显优势。结论 t PSA、f PSA及%f PSA套餐作为简便、快捷、无创的方法,广泛用于前列腺疾病的早期判断,但针对不同的临床使用需求,三项检测的合理化使用在保证疾病判断准确性的同时,减少不必要的医疗负担。Objective To explore an optimal way to screen and diagnosis of benign and malignant prostate disease with prostate specific antigen（tPSA） ,free prostate specific antigen（fPSA） and the % fPSA. Methods Serum tPSA and fPSA levels were measured with Electrochemical luminescene assay （ECLIA）in patients with prostate disease（ 160 prostate cancer, 160 prostatic hyperplasia）on the basis of pathological examination and 160 health people. Results The M（X25% -X75%）value of tPSA, fPSA and % fPSA in prostate cancer group were 54.48（13.69-100.00）μg/L,5.50 （ 1.67-17.27 ）μg/L and 0.16 （0.11-0.28） and those in prostatic hyperplasia group were 6.50 （2.73-11.37 ） μg/L, 0.88 （ 0.45-1.59 ）μg/L, 0.16 （0.10-0.22） respectively, statistically significant（ P 〈 0.05 ） different compared with those in control group 1.45 （0.5-2.6） μg/L, 0.35 （0.19-0.76） μg/L,0.34 （0. 19-0.66）. The area under the receiver operating characteristic （ROC）curve were 0. 938,0. 941 and 0. 733 for tPSA, fPSA and % fPSA, respectively. The tPSA and fPSA showed good screening capacity for prostate disease. ROC analysis of tPSA, fPSA and % fPSA, performed in 85 prostatic hyperplasia cases and 38 prostate cancer cases with a PSA between 4 and 10 μg/L,indicated that the ROC for % fPSA（AUC =0. 855） was larger than for fPSA（AUC =0.712） and tPSA（AUC =0. 569） （P 〈0.05） ,50% fPSA showed promising advantages in prostate cancer diagnosis in testing gray area. Conclusion tPSA, fPSA and % fPSA model, which acted as a simple, convenient and noninvasive method, played an important role in screening of prostate disease and diagnosis of prostate cancer. For patients in Huanan area, the rational usage of this model would reduce medical treatment burden effectively without lowing the accuracy of disease judgment.

关 键 词：肿瘤标志物 前列腺癌 总PSA 游离PSA ROC分析 

分 类 号：R737.25[医药卫生—肿瘤]