尿液外泌体PCA3对PSA10~20ng/mL区间患者前列腺癌的诊断效能  

Diagnostic Value of Urinary Exosome PCA3 for Prostate Cancer in Patients with PSA 10~20 ng/mL

作　　者：胡德超 逯小飞 周本正 HU Dechao;LU Xiao-fei;ZHOU Ben-zheng(Department of Urology,Xiangyang NO.1 People′s Hospital,Hubei University Of Medicine,Xiangyang,Hubei 44100,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院,湖北襄阳441100

出　　处：《湖北医药学院学报》2023年第2期148-152,158,共6页Journal of Hubei University of Medicine

基　　金：湖北省自然科学基金面上项目(2020CFB515)。

摘　　要：目的:探讨尿液外泌体中前列腺癌基因3(PCA3)对前列腺特异性抗原(PSA)10~20 ng/mL区间患者前列腺癌(PCa)的诊断价值。方法:选择2018年7月至2021年12月就诊于我院体检中心PSA为10~20 ng/mL的患者145例,收集患者的一般资料,行经直肠前列腺穿刺前采集患者MRI影像学信息、静脉血及直肠指诊后前段尿液,完善患者血清PSA、%fPSA、PSAD、尿PCA3评分、直肠指诊结果及PI-RADS评分,以患者前列腺穿刺活检组织病理结果为诊断金标准,应用受试者工作特征(ROC)曲线分析尿液外泌体PCA3、血清PSA及二者联合对PSA为10~20 ng/mL区间患者前列腺癌的诊断效能。结果:145例患者中诊断为前列腺癌患者(PCa组)42例,穿刺结果为前列腺增生患者(BPH组)103例,尿外泌体PCA3评分ROC曲线下面积为0.665(95%CI=0.555~0.774),明显高于血清TPSA及其衍生标记物%fPSA、PSAD(0.600、0.604、0.578),两两比较,差异无统计学意义(P>0.05)。当尿PCA3评分联合TPSA诊断前列腺癌时,其敏感度及特异度分别为71.8%、83.3%,二者联合诊断较TPSA及尿PCA3评分单一诊断的敏感度及特异度明显提高,ROC曲线下面积0.763(95%CI=0.670~0.856),差异有统计学意义(P=0.023、0.046)。结论:尿外泌体PCA3评分对血清PSA 10~20 ng/mL区间患者有更好PCa预测价值,尿外泌体PCA3评分联合血清TPSA诊断PCa的敏感度及特异度明显提高,明显增加此区间患者PCa的阳性预测率。Objectives To investigate the diagnostic value of prostate cancer gene 3(PCA3)in urine exosomes for prostate cancer(PCa)in patients with prostate-specific antigen(PSA)in the range of 10-20 ng/mL.Methods A total of 145 pa⁃tients with PSA of 10-20 ng/mL in the physical examination center of our hospital from July 2018 to December 2021 were selected,and the general information of the patients was collected.Before the transrectal prostate puncture,MRI imaging information,venous blood and anterior segment urine after rectal finger examination were collected,and the serum PSA,%fPSA,PSAD,urine PCA3 score,rectal finger examination results and PI-RADS score were performed.The histopathologi⁃cal results of biopsy were the gold standard for diagnosis,and the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of urinary exosome PCA3,serum PSA and the combination of the two for prostate cancer in patients with PSA 10-20 ng/mL.Results Among 145 patients,42 were diagnosed with prostate cancer(PCa group),103 were diagnosed with prostate hyperplasia(BPH group),and the area under the ROC curve of the PCA3 score for uri⁃nary extracellular vesicles was 0.665(95%CI=0.555~0.774),significantly higher than serum TPSA and its derivative markers%fPSA,PSAD(0.600,0.604,0.578),and there was no statistically significant difference(P>0.05).When the urine PCA3 score combined with TPSA was used to diagnose prostate cancer,its sensitivity and specificity were 71.8%and 83.3%.The sensitivity and specificity of the combined diagnosis of TPSA and urine PCA3 scores were significantly im⁃proved compared to a single diagnosis,with an area under the ROC curve of 0.763(95%CI=0.670~0.856),and the difference was statistically significant(P=0.023,0.046).Conclusions The PCA3 score of urinary exosome has better pre⁃dictive value for PCa in patients with serum PSA in the range of 10-20 ng/mL.The combination of PCA3 score of urinary exosome and serum TPSA significantly increases the sensitivity and specificity of di

关 键 词：外泌体 前列腺癌基因3 前列腺癌 前列腺特异性抗原 

分 类 号：R737.25[医药卫生—肿瘤]