t-PSA及其衍生指标PHI和PI-RADS评分对前列腺癌诊断效能的评价  

Diagnostic efficacy evaluation of t-PSA and its derived indicator PHI and PI-RADS score for prostate cancer

作　　者：张勤[1] 姚瀚鑫[1] 王伯玉 巨昕薇 续薇[1] ZHANG Qin;YAO Hanxin;WANG Boyu;JU Xinwei;XU Wei(Department of Clinical Laboratory,the First Hospital of Jilin University,Changchun 130021,Jilin,China;Department of Radiology,the First Hospital of Jilin University,Changchun 130021,Jilin,China)

机构地区：[1]吉林大学第一医院检验科,吉林长春130021 [2]吉林大学第一医院放射线科,吉林长春130021

出　　处：《检验医学》2024年第11期1084-1090,共7页Laboratory Medicine

摘　　要：目的探讨总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA)占t-PSA的百分比(f-PSA/t-PSA%)、前列腺健康指数(PHI)和前列腺影像及报告数据系统(PI-RADS)评分对前列腺癌的诊断效能。方法选取2022年7月—2024年2月吉林大学第一医院经病理检查确诊的前列腺疾病患者277例,按病理诊断分为良性疾病组(143例)、前列腺癌组(134例),按t-PSA水平分为t-PSA<20 ng·mL^(-1)组(147例,其中良性疾病100例、前列腺癌47例)、t-PSA≥20 ng·mL^(-1)组(130例,其中良性疾病43例、前列腺癌87例)。检测所有患者血清t-PSA、f-PSA和前列腺特异性抗原同源异构体2(p2PSA),计算f-PSA/t-PSA%,并进行PIRADS评分。采用Logistic回归分析评估前列腺癌发生的影响因素。采用受试者工作特征(ROC)曲线评价各项指标诊断前列腺癌的效能。结果前列腺癌组t-PSA和PHI显著高于良性疾病组(P<0.001),f-PSA/t-PSA%显著低于良性疾病组(P<0.001);PI-RADS评分≥4分所占比例高于良性疾病组(P<0.001)。t-PSA、f-PSA/t-PSA%、PHI和PI-RADS评分诊断前列腺癌的曲线下面积(AUC)分别为0.752、0.633、0.913、0.881。PHI和PI-RADS评分是前列腺癌发生的独立危险因素[比值比(OR)值分别为1.035、2.520,95%可信区间(CI)分别为1.021~1.049、1.672~3.800,P<0.001]。在t-PSA<20 ng·mL^(-1)组中,与良性疾病患者比较,前列腺癌患者PHI和PI-RADS评分≥4分所占比例均显著升高(P<0.001),f-PSA/t-PSA%降低(P<0.05),t-PSA水平差异无统计学意义(P>0.05)。在t-PSA≥20 ng·mL^(-1)组中,与良性疾病患者比较,前列腺癌患者t-PSA水平、PHI和PI-RADS评分≥4分所占比例均显著升高(P<0.001),f-PSA/t-PSA%差异无统计学意义(P>0.05)。t-PSA、f-PSA/t-PSA%、PHI和PI-RADS评分单项检测诊断t-PSA<20 ng·mL^(-1)前列腺癌的AUC分别为0.561、0.611、0.836、0.834;4项指标联合检测的AUC最高,为0.900;单项检测诊断t-PSA≥20 ng·mL^(-1)前列腺癌的AUC分别为0.822、0.520、0.963、0.875Objective To investigate the diagnostic efficacy of total prostate-specific antigen(t-PSA),the percentage of free prostate-specific antigen(f-PSA)to t-PSA(f-PSA/t-PSA%),prostate health index(PHI)and prostate imaging reporting and data system(PI-RADS)score in the diagnosis of prostate cancer.Methods Totally,277 patients with prostate diseases diagnosed by pathological examination from July 2022 to February 2024 in the First Hospital of Jilin University were classified into benign disease group(143 cases)and prostate cancer group(134 cases).They were classified into t-PSA<20 ng·mL^(-1)group(147 cases,including 100 cases of benign disease and 47 cases of prostate cancer)and t-PSA≥20 ng·mL^(-1)group(130 cases,including 43 cases of benign disease and 87 cases of prostate cancer)according to t-PSA level.The serum t-PSA,f-PSA and isoform[-2]prostate-specific antigen(p2PSA)of all the patients were determined,and the f-PSA/t-PSA%was calculated.The PI-RADS score was evaluated.Logistic regression analysis was used to assess the factors for prostate cancer.The diagnostic efficacy of each indicator was evaluated by receiver operating characteristic(ROC)curve.Results The t-PSA and PHI in prostate cancer group were higher than those in benign disease group(P<0.001),and f-PSA/t-PSA%was lower than that in benign disease group(P<0.001).The proportion of PI-RADS score≥4 was higher than that of benign disease group(P<0.001).The areas under curves(AUC)of t-PSA,f-PSA/t-PSA%,PHI and PI-RADS for the diagnosis of prostate cancer were 0.752,0.633,0.913 and 0.881,respectively.PHI and PI-RADS score were independent risk factors for prostate cancer[odds ratios(OR)were 1.035 and 2.520,95%confidence intervals(CI)were 1.021-1.049 and 1.672-3.800,respectively,P<0.001].In t-PSA<20 ng·mL^(-1)group,compared with benign disease patients,PHI and PI-RADS score≥4 proportion in prostate cancer patients were increased(P<0.001),f-PSA/t-PSA%was decreased(P<0.05),and there was no statistical significance in t-PSA level(P>0.05).In t-PSA≥20 ng·mL^

关 键 词：总前列腺特异性抗原 游离前列腺特异性抗原 前列腺健康指数 前列腺影像及报告数据系统评分 前列腺癌 

分 类 号：R446.62[医药卫生—诊断学]