尿PCA3 mRNA密度定量检测在PSA灰区前列腺癌诊断中的应用  

Value of quantitative detection of urine PCA3 mRNA density in the diagnosis of prostate cancer in PSA grey zone

作　　者：王健 刘定益 周燕峰 唐崎 李文敏 夏维木 俞家顺 WANG Jian;LIU Ding-yi;ZHOU Yan-feng;TANG Qi;LI Wen-min;XIA Wei-mu;YU Jia-shun(Department of Urology,Shanghai Punan Hospital,Pudong 200125,Shanghai,CHINA)

机构地区：[1]上海浦东新区浦南医院泌尿外科

出　　处：《海南医学》2019年第23期3044-3047,共4页Hainan Medical Journal

基　　金：上海市浦东新区科技发展基金(编号:PKJ2016-Y04)

摘　　要：目的研究尿PCA3 m RNA密度定量检测在前列腺特异性抗原(PSA)灰区前列腺癌(PCa)诊断中的应用价值,为临床诊断提供指导。方法选取上海浦东新区浦南医院泌尿外科2017年5月至2019年2月收治的52例PCa患者(PCa组)和50例前列腺增生(BPH)患者(BPH组)进行研究,采集其前列腺按摩后尿液,离心后取细胞沉淀物提取总RNA,应用实时荧光定量RT-PCR方法检测PCA3 mRNA含量,应用直肠B超测定前列腺体积,计算PCA3 mRNA密度(PCA3 mRNA/D)。以PSA mRNA对尿液中前列腺癌细胞进行校正,PCA3 mRNA含量为PCA3 m RNA/PSA mRNA。以术后病理检查或者穿刺活检检查结果作为金标准,应用ROC曲线评价PCA3 mRNA密度定量检测在PSA灰区前列腺癌诊断中的性能,分析其在PSA灰区前列腺癌诊断中的应用价值。结果BPH组患者总PSA水平为(6.34±1.48)ng/mL,明显低于PCa组的(8.96±1.31)ng/mL,差异有统计学意义(P<0.05);BPH组患者的PCA3 mRNA/PSA m RNA比值为0.13±0.17,明显低于PCa组的0.37±0.20,PCA3 mRNA/D比值为1.58±0.28,也明显低于PCa组的2.26±2.16,差异均有统计学意义(P<0.05);经ROC曲线分析,当截断值为2.01时,尿PCA3 mRNA/D诊断PCa的曲线下面积为0.915(95%CI:0.793~0.897),其诊断灵敏度为93.75%、特异度为66.67%、准确度为80.21%。当截断值为0.27时,尿PCA3 m RNA/PSA m RNA诊断PCa的曲线下面积为0.851(95%CI:0.673~0.995),其诊断灵敏度为85.42%、特异度为74.07%、准确度为79.74%。结论尿PCA3 mRNA密度定量检测能够明显提高PSA灰区PCa检出的敏感度,可应用于早期疾病诊断。Objective To study the value of quantitative detection of urinary PCA3 mRNA density in the diagnosis of prostate cancer(PCa)in prostate-specific antigen(PSA)gray area,and provide guidance for clinical diagnosis.Methods Fifty-two patients with PCa(PCa group)and fifty patients with benign prostatic hyperplasia(BPH group)were enrolled in the Department of Urology,Shanghai Punan Hospital from May 2017 to February 2019.The urine of the patient after the prostate massage was collected,and the total RNA was extracted from the cell pellet after centrifugation.The mRNA content of PCA3 was detected by real-time quantitative RT-PCR,rectal B-ultrasound was applied to determine prostate volume,PCA3 mRNA density was calculated(PCA3 mRNA/D).PSA mRNA was used to correct prostate cancer cells in the urine,and PCA3 mRNA/PSA mRNA was PCA3 mRNA content.Using postoperative pathological examination or biopsy results as the gold standard,ROC curve was used to evaluate the performance of PCA3 mRNA density quantitative detection in PSA gray area prostate cancer diagnosis,and its application value in the diagnosis of prostate cancer in PSA gray area was analyzed.Results The total PSA level in the BPH group was(6.34±1.48)ng/mL,which was significantly lower than(8.96±1.31)ng/mL in the PCa group(P<0.05).The ratio values of PCA3 mRNA/PSA m RNA and PCA3 mRNA/D in the BPH group were 0.13±0.17 and 1.58±0.28,which were significantly lower than corresponding 0.37±0.20 and 2.26±2.16 in the PCa group(all P<0.05).According to ROC curve analysis,when the cutoff value was 2.01,the area under the curve of urinary PCA3 mRNA/D for diagnosing PCa was 0.915(95%CI:0.793-0.897),the diagnostic sensitivity was 93.75%,the specificity was 66.67%,and the accuracy was 80.21%.When the cutoff value was 0.27,the area under the curve of urinary PCA3 mRNA/PSA mRNA for diagnosis of PCa was0.851(95%CI:0.673-0.995),and its diagnostic sensitivity was 85.42%,specificity was 74.07%,and accuracy was79.74%.Conclusion Quantitative detection of urinary PCA3 mRNA density has

关 键 词：前列腺癌 前列腺癌抗原基因3 前列腺特异性抗原密度 灰区 前列腺特异性抗原 总前列腺特异性抗原 诊断价值 

分 类 号：R737.25[医药卫生—肿瘤]