| PSA相关指标在前列腺重复穿刺活检中的诊断价值 |
| 投稿时间：2015-12-23 修订日期：2016-01-17 点此下载全文 |
| 引用本文：陈磊,王韧,白文坤,胡兵,周永昌,张心如,冯超.PSA相关指标在前列腺重复穿刺活检中的诊断价值[J].医学研究杂志,2016,45(12):89-92,149 |
| DOI：
10.11969/j.issn.1673-548X.2016.12.024 |
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| 基金项目:上海交通大学医工交叉项目（YG2014MS17） |
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| 中文摘要:目的 探讨分析PSA相关指标在前列腺重复穿刺活检中的诊断价值。方法 自2008年1月1日~2015年4月1日，在笔者医院超声医学科进行超声引导下前列腺穿刺4315例患者中，筛选出145例进行了重复穿刺的患者进行分析，按第2次穿刺结果将患者分为肿瘤组以及非肿瘤组。分析指标包括患者年龄、两次穿刺间隔时间、穿刺针数、前列腺特异抗原（prostate specific antigen，PSA）、前列腺特异抗原速率（prostate specific antigen rate，PSAV）、血清游离前列腺特异性抗原与总前列腺特异性抗原比值（freeprostate specific antigen/total prostate specific antigen，f/tPSA）、前列腺特异性抗原密度（prostate specific antigen density，PSAD）、前列腺特异性抗原移形带密度（prostate specific antigen density transitional zone，PSATZ）。对所有入选患者中63例初次穿刺PSA位于灰区且穿刺间隔超过1年的患者进行进一步分层研究，分为灰区肿瘤组和灰区非肿瘤组。结果 第2次穿刺针证实为前列腺癌的共有42例，阳性率28.97%（42/145）。按第2次穿刺结果将病患分为肿瘤组以及非肿瘤组进行比较，两组患者穿刺间隔时间和穿刺针数相比较，差异无统计学意义（P>0.05）。两组患者年龄相比较，肿瘤组大于非肿瘤组，差异有统计学意义（P<0.05）。两组患者PSATZ相比较，肿瘤组明显大于非肿瘤组，差异有统计学意义（P<0.05）。两组患者两次穿刺间PSA差相比较，肿瘤组明显大于非肿瘤组，差异有统计学意义（P<0.05）。肿瘤组与非肿瘤组PSA差ROC曲线分析显示，其ROC曲线下面积（AUC）为0.587，最佳诊断临界值为>2.588ng/ml。穿刺点位于灰区的肿瘤组和非肿瘤组PSAV相比较，肿瘤组明显大于非肿瘤组，差异有统计学意义（P<0.05）。灰区肿瘤组与非肿瘤组PSAV的ROC曲线分析显示，其ROC曲线下面积（AUC）为0.593，最佳诊断临界值为每年>1.648ng/ml。结论 前列腺穿刺活检仍属有创检查，患者有一定痛苦且有可能引起较严重并发症，应谨慎行再次穿刺。当患者两次PSA差>2.588ng/ml时是进行重复穿刺的强指征。对PSA位于灰区的患者当每年PSAV>1.648ng/ml是续行重复穿刺的观察指标。只有把握合适的指征才能在真正减少患者痛苦的同时提高诊断率。 |
| 中文关键词:前列腺癌 前列腺穿刺活检 前列腺特异抗原 |
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| Diagnostic Value of PSA Related Indicators of Repeat Biopsy in Prostate |
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| Abstract:Objective To investigate the diagnostic value of PSA related indicators in repeating of prostate biopsy.Methods One hundred and forty five cases were screened from a total of four thousand and three hundred fifteen cases that had received ultrasound-guided prostate biopsy in our department to have repeat biopsy. They were divided into oncology group and non-cancer group in accordance with secondary tumor biopsy results. Analysis indicators include patient age, two puncture intervals, needle count, PSA, PSAV, f/tPSA, PSAD, PSATZ. Sixty three cases for the first time PSA puncture locating in gray zone over one year interval were chose from all patients for further stratification. They were divided into the gray area of the tumor group and the gray area of non-tumor group.Results Forty-two cases were diagnosed with prostate cancer according to the second puncture results, and the positive rate was 28.97%(42/145). Comparing the oncology group with non-tumor group which were divided according to the results of the second puncture showed that needle puncture interval and the number of phases of two groups had no statistically significant difference (P>0.05).The results of analysis indicators like age of patients, PSATZ and PSA indicated that the index value in tumor group exceeder than he non-tumor group, the difference was statistically significant (P<0.05). PSA curve ROC analysis in cancer group and non-cancer group showed that the area under the ROC curve(AUC) was 0.587 and the best diagnostic cutoff value was more than 2.588ng/ml. PSAV was compared between tumor and non-tumor group which puncture site was located in the gray zone. The results demonstrated that the value of tumor group was significantly higher than non-tumor group which was statistically significant (P<0.05). PSAV curve ROC analysis between gray area tumor group and non-tumor group indicated that area under the ROC curve(AUC) was 0.593 and the best diagnostic cutoff value was more than 1.648ng/ml every year.Conclusion The prostate biopsy is still an invasive examination which can make patients have some pain and lead to more serious complications so that re-puncture should becautious. PSA difference is higher than 2.588ng/ml is strong testify to have patients received repeated puncture. Moreover, when the PSAV of the patients whose PSA is located in the gray area is more than 1.648ng/ml every year, it is anexactly observe indicator to have continuation repeated puncture. Only by grasping the appropriate indications can really reduce the suffering of patients and improve the diagnosis rate at the same time. |
| keywords:Prostatic carcinoma Needle biopsy of the prostate Prostate specific antigen |
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