NLR联合fPSA/tPSA及PSAD对PSA灰区前列腺癌的诊断价值  

Diagnostic value of NLR combined with fPSA/tPSA and PSAD for prostate cancer within serum prostate-specific antigen gray zone

作　　者：田齐星 柯炳虎 叶青林 徐玉节 陶良俊 敖平 Tian Qixing;Ke Binghu;Ye Qinglin;Xu Yujie;Tao Liangjun;Ao Ping(The First Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241004,China;The Second Affiliated Hospital of Wannan Medical College,Wuhu,Anhui,230601,China)

机构地区：[1]皖南医学院第一附属医院,安徽芜湖241004 [2]安徽医科大学第二附属医院,安徽合肥230601

出　　处：《齐齐哈尔医学院学报》2023年第24期2307-2311,共5页Journal of Qiqihar Medical University

基　　金：安徽省高校哲学社会科学研究优秀科研创新团队项目基金(2023AH010076);皖南医学院重点项目科研基金(WK2022ZF07)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)联合血清游离前列腺特异性抗原(fPSA)与总前列腺特异性抗原(tPSA)比值(fPSA/tPSA)及PSA密度(PSAD)在PSA灰区前列腺癌中的诊断价值。方法回顾性分析2018年1月—2021年1月本院收治的181例PSA为4~10 ng/ml,经穿刺活检或术后病理证实为良性前列腺增生症(BPH)或前列腺癌(PCa)的男性患者的临床资料,其中良性前列腺增生患者101例(BPH组),前列腺癌患者80例(PCa组)。收集所有患者的年龄、血清tPSA、fPSA、中性粒细胞和淋巴细胞计数及前列腺体积等数据,并计算NLR、fPSA/tPSA及PSAD。对比分析BPH组和PCa组的各指标水平及各指标单独及联合用于诊断前列腺癌的诊断效能。结果与BPH组比较,PCa组血清NLR、t-PSA及PSAD水平均明显升高(P<0.05)而前列腺体积与fPSA/tPSA降低(P<0.05);ROC曲线显示NLR、PSAD及fPSA/tPSA指标曲线下面积分别为0.69、0.74、0.67,ROC曲线对比分析显示三者差异无统计学意义(P>0.05);将NLR、PSAD及fPSA/tPSA三者联合后行ROC曲线分析显示曲线下面积为0.81,诊断灵敏度和特异度分别为76.2%和75.2%。对比分析显示三者联合的曲线下面积优于任一单独指标(P<0.05)。此外,以2.11截点为界将前列腺癌患者分为高NLR组(NLR>2.11)和低NLR组(NLR≤2.11),高NLR组中高危前列腺癌患者的比例明显高于低NLR组。结论NLR、fPSA/tPSA及PSAD对PSA灰区前列腺癌具有较高诊断价值,且NLR联合f-PSA/t-PSA及PSAD可显著提高PSA灰区前列腺癌的检出率。此外,NLR以2.11为截点可一定程度反映前列腺癌的危险度。Objective To investigate the value of neutrophil-lymphocyte ratio(NLR)combined with serum free prostate-specific antigen/total prostate-specific antigen(fPSA/tPSA)ratio and PSA density(PSAD)in diagnosing prostate cancer within serum PSA gray zone.Methods The clinical data of 181 male patients those were admitted to the hospital from January 2018 to January 2021 were analyzed retrospectively,the serum PSA concentration of the patients was arranged from 4 to 10 ng/mL,and they were confirmed to suffer from benign prostatic hyperplasia(BPH)or prostate cancer(PCa)by needle biopsy or postoperative pathology.There were 101 patients with benign prostatic hyperplasia(BPH group)and 80 patients with prostate cancer(PCa group).Data such as age,serum tPSA,serum fPSA,neutrophil and lymphocyte count,and prostate volume of all patients were collected.The NLR,fPSA/tPSA,and PSAD were calculated.The levels of every indicator in BPH group and PCa group were compared,and the efficacy of each indicator in diagnosing prostate cancer was analyzed.Results Compared with BPH group,serum NLR,t-PSA and PSAD levels in PCa group were significantly increased(P<0.05),while prostate volume and fPSA/tPSA decreased(P<0.05).ROC curve showed the AUC of NLR,PSAD,and fPSA/tPSA were 0.69,0.74,0.67 respectively.The comparative analysis of ROC curve showed that the difference of AUC was not statistically significant(P>0.05).After combining NLR,PSAD and fPSA/tPSA,ROC curve analysis showed that the AUC was 0.81,and the diagnostic sensitivity and specificity were 76.2%and 75.2%,respectively.Comparative analysis showed that the AUC of the combination was higher than any single indicator(P<0.05).In addition,prostate cancer patients were divided into the high-NLR group(NLR>2.11)and the low-NLR group(NLR≤2.11)based on the 2.11 cut-off point.The proportion of high-risk prostate cancer patients in the high-NLR group was significantly higher than that in the low-NLR group.Conclusions NLR,fPSA/tPSA,and PSAD have high diagnostic value for prostate cancer within PSA

关 键 词：前列腺癌 前列腺特异性抗原 中性粒细胞与淋巴细胞比值 

分 类 号：R737.25[医药卫生—肿瘤]