前列腺按摩后尿沉渣AMACR检测在前列腺癌早期诊断中的研究  

The detection of urinary sediment A MA CR in the early diagnosis of prostate cancer after prostate massage

作　　者：李峰 马权 陈永良 李东章 李王坚 Li Feng

机构地区：[1]中国医科大学绍兴医院(绍兴市中心医院),312030

出　　处：《浙江临床医学》2019年第12期1612-1615,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省卫计委项目(2019zhO52);绍兴市科技局基金项目(2013D10030)。

摘　　要：目的通过对前列腺穿刺患者尿渣样本中AMACR mRNA检测评分,探讨其在穿刺患者中的诊断作用.方法收集2015年3月至2017年3月行前列腺穿刺的198例患者按摩后的晨尿,应用qRT-PCR技术检测尿渣中AMACR mRNA和PSA mRNA的表达量.AMACR评分使用AMACR mRNA/PSA mRNA×1000进行计算.运用受试者工作曲线(ROC)和临床决策曲线(DCA)评估AMACR评分的临床诊断价值并与血清PSA诊断作用进行比较.结果总体样本和"PSA诊断灰区"样本的穿刺阳性率分别为42.93%和24.47%.在总体样本中,穿刺阳性率分别为42.93%,且穿刺阳性AMACR评分明显高于阴性(P=0.004).前列腺血清PSA、AMACR和两者合用的ROC曲线下面积(AUC)分别为0.721、0.717和0.798.AMACR评分与血清PSA的诊断价值无统计学差异(P=0.947),两者合用优于血清PSA(P=0.009)或AMACR评分(P=0.007).在PSA4-10的"PSA诊断灰区"患者中,穿刺阳性率为24.47%(23/94),同样,穿刺阳性AMACR评分明显高于阴性(P=0.004),但血清PSA无法区分阴性与阳性患者(P=0.5210).血清PSA、AMACR评分和两者联用曲线下面积为0.545、0.698和0.707.AMACR评分诊断价值有优于血清PSA的趋势,但两者相比无统计学差异(P=0.117).血清PSA和AMACR评分两者联用显示出了更高的临床诊断价值.进一步的DCA分析表明,基于尿液AMACR评分的诊断模型的诊断价值明显优于临床信息的基础诊断模型.结论尿液AMACR评分在前列腺穿刺患者中有良好的预测作用,其与血清总PSA联合应用可提高预测总体患者的准确性,单用尿液AMACR评分对PSA灰区患者有较好的预测作用.Objective To investigate the diagnostic role of AMACR mRNA detection in puncture patients by its detection score of the urinary sediment samples from patients with prostate puncture.Methods The urina sanguinis after massage of 198 patients who underwent prostate puncture in our hospital from March 2015 to March 2017 were collected.QRT-PCR technology was applied to detect the expression quantity of AMACR mRNA and PSA mRNA in urinary sediment.The AMACR score was calculated using AMACR mRNA/PSA niRNA×1000.The clinical diagnostic value of the AMACR score was assessed using the receiver operating curves(ROC)and clinical decision curve analysis(DCA)and compared to the diagnostic role of serum PSA.Results The positive rates of puncture in the overall sample and the*P*SA diagnostic gray area"samples were 42.93%and 24.47%,respectively.In the overall sample,the positive rate of puncture was 42.93%,and the AMACR score of puncture positive was significandy higher than that of negative(P=0.004).The area under the ROC curve(AUC)of the prostate semm PSA.AMACR and the combination of the two were 0.721,0.717 and 0.798,respectively.There was no statistical difference between the diagnostic value of the AMACR score and that of serum PSA(P=0.947).The combination of the two was superior to serum PSA(P=0.009)or AMACR score(P=0.007).In the PSA4-10"PSA diagnostic gray area"patients,the positive rate of puncture was 24.47%.Similarly,the AMACR score of puncture positive was significantly higher than that of the negative(P=0.004),but serum PSA could not distinguish between negative and positive patients(P=0.5210).The areas under curve of serum PSA,AMACR score,and the combination of the two were 0.545,0.698,and 0.707.There was a trend that the diagnostic value of AMACR score was superior to serum PSA,but there was no statistical difference between the two(P=0.117).The combined application of serum PSA and AMACR score showed a higher clinical diagnostic value.Further DCA analysis showed that the diagnostic value of the diagnostic model base

关 键 词：基因 前列腺癌 诊断 

分 类 号：R73[医药卫生—肿瘤]