前列腺健康指数在基层医院优化前列腺穿刺人群方面的初步应用  

The Preliminary Application of Prostate Health Index in Optimizing Prostate Biopsy Population in Primary Hospitals

作　　者：李亦君[1] 刘娜[2] 张曼[2] LI Yijun;LIU Na;ZHANG Man(Department of Laboratory of Medicine,Dongzhimen Hospital(Tongzhou Campus),Beijing University of Chinese Medicine,Beijing 101121,China;Department of Laboratory of Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]北京中医药大学东直门医院通州院区检验科,北京101121 [2]首都医科大学附属北京世纪坛医院检验科,北京100038

出　　处：《标记免疫分析与临床》2020年第10期1727-1731,共5页Labeled Immunoassays and Clinical Medicine

基　　金：尿液细胞分子诊断北京市重点实验室建设经费(编号:2020-JS02)。

摘　　要：目的探讨对于血清前列腺特异抗原(PSA)4~20μg/L且符合前列腺穿刺指征的基层医院病例,前列腺特异性抗原同源异构体2(p2PSA)和前列腺健康指数(PHI)在前列腺癌诊断中的价值。方法对2019年4月到2020年3月在北京中医药大学东直门医院通州院区就诊的、PSA 4~20μg/L且符合前列腺穿刺指征的男性患者进行回顾性研究。应用Unicel DXI 800全自动化学发光仪对符合入选标准的40例就诊患者进行PSA、fPSA和p2PSA的检测,并计算f/t PSA和PHI。以穿刺结果为金标准,采用SPSS软件进行统计分析,比较两组患者各血清指标的差异;同时绘制受试者工作特征(ROC)曲线,比较p2PSA和PHI相比传统标志物(PSA和f/t PSA)在前列腺癌中的诊断效能。结果PSA 4~20μg/L且符合前列腺穿刺指征的男性患者中,根据穿刺结果,前列腺癌组和非前列腺癌组患者仅p2PSA和PHI差异具有统计学意义[p2PSA(ng/L):61.32(33.70~138.60)vs 12.48(6.69~17.24),P<0.001;PHI:119.82(84.55~211.71)vs 42.58(33.16~49.69),P<0.001]。p2PSA和PHI在前列腺癌诊断中具有更高准确性,AUC分别为0.893和0.923,远大于经典指标PSA和f/tPSA(AUC分别为0.688和0.570,P<0.05)。结论在PSA 4~20μg/L且符合前列腺穿刺指征的就诊患者中,p2PSA和PHI能显著提高前列腺癌诊断的准确性,尤其是对于基层医院可作为前列腺癌辅助诊断新指标助力临床决策。Objective To explore the prostate cancer diagnosis efficacy of prostate specific antigen isomer 2(p2PSA)and prostate health index(PHI)for patients in the primary hospitals,who are eligible for the prostate biopsy with serum prostate specific antigen(PSA)4-20μg/L.Methods A retrospective study was conducted among male patients with PSA 4-20μg/L who met the requirements for prostate biopsy from April,2019 to March,2020 in the Tongzhou campus of Dongzhimen Hospital,Beijing University of Chinese Medicine.Serum PSA,fPSA and p2PSA of 40 eligible patients were tested using the Beckman Coulter DxI-800 automatic chemiluminescence analyzer(Beckman Coulter,Brea,CA).The corresponding f/t PSA and PHI values were then calculated.Taking the biopsy results as the gold standard for the diagnosis,a statistical analysis was performed using SPSS software to evaluate the differences in the serum indicators between the two groups of patients.The receiver operating characteristic(ROC)curve was also drawn to assess the diagnostic efficacy of p2PSA and PHI,compared to traditional markers(PSA and f/t PSA)for prostate cancer.Results Among tested male patients with PSA 4-20μg/L and eligible for prostate biopsy,according to the biopsy results,only the differences of p2PSA and PHI between patients with and without prostate cancer were statistically significant[p2PSA(ng/L):61.32(33.70-138.60)vs.12.48(6.69-17.24),P<0.001;PHI:119.82(84.55-211.71)vs.42.58(33.16-49.69),P<0.001].p2PSA and phi had higher accuracies in the diagnosis of prostate cancer,with AUC of 0.893 and 0.923,respectively,which were much larger than the traditional biomarkers,PSA and f/tPSA(AUC were 0.688 and 0.570,respectively,P<0.05).Conclusion Among the patients with PSA 4-20μg/L and eligible for prostate biopsy,p2PSA and PHI test results can significantly improve the accuracy of prostate cancer diagnosis,especially in primary hospitals,which can be used as a novel indicator of the auxiliary diagnosis of prostate cancer to facilitate clinical decision-making process.

关 键 词：前列腺健康指数 前列腺穿刺 前列腺癌 诊断 

分 类 号：R737.25[医药卫生—肿瘤]