血清PHI和尿PCA3联合检测评分对PSA灰区前列腺癌诊断价值探讨  

Value of PHI combined with urine PCA3 score in the diagnosis of prostate cancer patients with PSA gray zone

作　　者：张振奇 刘桂丽 夏小彬[1] 毛仕辉[1] 封志强[1] 江冰华 陈月娥[1] 叶惠珍 许志宏[1] ZHANG Zhen-qi;LIU Gui-li;XIA Xiao-bin;MAO Shi-hui;FENG Zhi-qiang;J IANG Bing-hua;CHEN Yue-e;YE Hui-zhen;XU Zhbhong(Department of Urology ,First Hospital of Nanping City Affiliated to Fujian Medical University, Nanping 353000, P. R. Chin)

机构地区：[1]福建医科大学附属南平市第一医院泌尿外科,福建南平353000

出　　处：《中华肿瘤防治杂志》2018年第5期329-333,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：福建省卫生计生委青年科研课题(2015-1-109)

摘　　要：目的前列腺癌是影响老年男性健康的常见的恶性肿瘤,诊断及筛查方法的改进是提高前列腺癌患者预后的关键问题之一。本研究探讨血清前列腺健康指数(prostate health index,PHI)和尿液前列腺癌基因3(prostate cancer gene 3,PCA3)评分联合检测在血清总PSA(total prostate specific antigen,tPSA)灰区(4~10ng/mL)前列腺癌患者中的诊断应用价值。方法收集福建医科大学附属南平市第一医院2015-06-01-2017-07-31经病理确诊的103例tPSA灰区患者的临床资料。其中前列腺癌组29例,前列腺良性增生(benign prostatic hyperplasia,BPH)组74例。检测tPSA、游离PSA(free PSA,fPSA)、前列腺特异性抗原前体(p2PSA)和尿液PCA3基因表达,分别计算PHI及尿PCA3评分,并以前列腺穿刺活检作为前列腺癌确诊依据,建立PHI及尿PCA3评分的受试者工作特征(receiver operating characteristic,ROC)曲线,分析PHI及尿PCA3评分单独检测及联合检测对前列腺癌患者早期诊断的应用价值。结果前列腺癌组与BPH组患者年龄(t=0.616,P=0.539)、血清tPSA(t=1.367,P=0.175)和P2PSA(t=1.255,P=0.212)水平差异无统计学意义;血清PHI(t=3.889,P<0.001)、尿PCA3评分(t值=4.175,P<0.001)、fPSA(t=-2.015,P=0.047)及前列腺体积(t=-3.875,P=0.002)差异有统计学意义,P>0.05。血清PHI及尿PCA3评分检测的AUC值显著高于血清tPSA,差异有统计学意义(P<0.05),两者联合检测的AUC值高于两者单独检测,但差异无统计学意义,P>0.05。结论 PHI及尿PCA3评分均可以作为前列腺癌诊断特异性肿瘤标志物,但两者联合检测并无协同作用。OBJECTIVE Prostate cancer is a common malignant tumor affecting the health of elderly men.The improvement of diagnosis and screening methods is one of the key points to improve the survival of prostate cancer patients.The aim of this study is to investigate the value of prostate health index（PHI）combined with urine prostate cancer gene 3（PCA3）score in the diagnosis of prostate cancer with serum total PSA（tPSA）at 4-10 ng/mL.METHODS The clinical data of 103 patients with tPSA at 4-10 ng/mL diagnosed by pathology from June 2015 to July 2017 were collected.Among them,there were 29 cases of prostate cancer and 74 cases of benign prostatic hyperplasia（BPH）.The levels of serum total prostate specific antigen（tPSA）,free PSA（fPSA）,prostate specific antigen precursor（p2 PSA）and urine PCA3 gene were detected.PHI and the PCA3 score were calculated,and the ROC curve was used to analyze the application value of PHI and urine PCA3 score on the early diagnosis of prostate cancer.RESULTS There was no difference in patient＇s age（t=0.616,P=0.539）,serum tPSA（t=1.367,P=0.175）and P2 PSA levels（t=1.255,P=0.212）between prostate cancer group and BPH group（P〈0.05）.There were significant differences in patient＇s serum PHI（t=3.889,P〈0.001）,fPSA（t=-2.015,P=0.047）,urinary PCA3 score levels（t=4.175,P〈0.001）and prostate volume（t=-3.875,P=0.002）.The diagnostic efficacy of PHI and urinary PCA3 score was significantly higher than that of serum tPSA（P〈0.05）.The AUC values of the combination group were higher than those of the PHI group and the urine PCA3 score group,but the difference was not statistically significant（P〈0.05）.CONCLUSION The PHI and urine PCA3 score can improve the accuracy of diagnosis of prostate cancerpatients with PSA gray zone,and can be used as the diagnostic marker for prostate cancer,but the combination of this two tests did not play synergistic effect.

关 键 词：前列腺癌 前列腺健康指数 尿前列腺癌基因3评分 

分 类 号：R737.25[医药卫生—肿瘤]