前列腺体积和炎性细胞浸润对前列腺穿刺活检阳性率的影响  

Relationship of prostate volume and inflammatory cell infiltration with the positive rate of prostate biopsy

作　　者：陶陶 夏开国 沈德贇 葛庆宇 李斌[1] 肖峻 宣强 TAO Tao;XIA Kai-guo;SHEN De-yun;GE Qing-yu;LI Bin;XIAO Jun;XUAN Qiang(Department of Urology,The First Hospital of the University of Science and Technology of China/Anhui Provincial Hospital,Hefei,Anhui 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)泌尿外科,安徽合肥230001

出　　处：《中华男科学杂志》2020年第5期409-413,共5页National Journal of Andrology

基　　金：国家自然科学基金(81702540);安徽省自然科学基金(1708085QH202)。

摘　　要：目的:探讨影响前列腺穿刺活检阳性率的因素,分析前列腺体积和炎性细胞浸润与前列腺穿刺活检阳性率之间的关系。方法:回顾性分析在我院泌尿外科行双平面经直肠超声引导下前列腺穿刺活检术的230例患者临床资料,收集患者年龄、体质指数(BMI)、血清总前列腺特异性抗原(tPSA)、前列腺体积(PV)、前列腺组织炎性细胞浸润等相关因素,通过二分类Logistic回归分析上述因素与前列腺穿刺病理结果之间的关系。结果:在230例前列腺穿刺患者中,穿刺阳性的有89例,阳性率为38.7%,其中tPSA<100ng/ml有196例,穿刺阳性的有56例,阳性率为28.57%,tPSA≥100μg/L的有34例,穿刺阳性的有33例,阳性率为97.06%。针对tPSA<100μg/L范围内临床资料进行分析发现,患者BMI对前列腺穿刺阳性率无显著影响(P>0.05),患者的年龄(P<0.01,OR=1.09)、tPSA(P<0.01,OR=1.04)、PSAD(P<0.01,OR=10.04)与穿刺阳性率呈正相关,患者前列腺体积(P<0.01,OR=0.98)和前列腺炎性细胞浸润(P<0.01,OR=0.22)与穿刺阳性率呈负相关。tPSA>10μg/L作为预测阳性结果的指标,敏感性为82.14%,特异性为35.71%;PSAD>0.26作为预测阳性结果的指标,敏感性为78.57%,特异性为71.43%。结论:前列腺体积增大和炎性细胞浸润导致tPSA非特异性增高,使得部分患者接受了不必要的穿刺活检;PSAD>0.26较tPSA>10μg/L对于指导前列腺穿刺活检更有临床应用价值。Objective:To investigate the factors influencing the positive rate of prostate biopsy and its relationship with the prostate volume and inflammatory cell infiltration(ICI).Methods:We retrospectively analyzed the clinical data on 230 cases of double-plane transrectal ultrasound-guided prostate biopsy in our Department of Urology,including the patients’age,body mass index(BMI),serum total prostate-specific antigen(tPSA),PSA density(PSAD),prostate volume,and ICI in the prostate tissue.We also investigated the relationship of the above factors with the pathological results of prostate biopsy by binary logistic regression analysis.Results:The positive rate of prostate biopsy was 38.7%(89/230)in the total number of cases,28.57%(n=56)in the 196 cases with tPSA<100μg/L,and 97.06%(n=33)in the 34 cases with tPSA≥100μg/L.Binary logistic regression analysis showed that the positive rate of prostate biopsy in those with tPSA<100μg/L was correlated positively with age(P<0.01,OR=1.09),tPSA(P<0.01,OR=1.04)and PSAD(P<0.01,OR=10.04),negatively with the prostate volume(P<0.01,OR=0.98)and ICI(P<0.01,OR=0.22),but not with BMI(P>0.05).As a predictor of positive prostate biopsy,tPSA>10μg/L exhibited a sensitivity of 82.14%and a specificity of 35.71%,while PSAD>0.26 showed a sensitivity of 78.57%and a specificity of 71.43%.Conclusion:Non-specific elevation of the tPSA level induced by increased prostate volume and inflammatory cell infiltration may lead to unnecessary biopsies in some patients.As a predictor of positive prostate biopsy,PSAD>0.26 has a higher clinical application value than tPSA>10μg/L.

关 键 词：前列腺癌 前列腺体积 前列腺特异性抗原 炎症细胞 穿刺活检 

分 类 号：R697.3[医药卫生—泌尿科学]