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目的探讨血清游离/总前列腺特异性抗原(f/tPSA)比值、睾酮(T)及游离睾酮(FT)的前列腺穿刺活检(TRUS)临界值,及其对PSA2~4ng/ml的前列腺疾病患者进行前列腺TRUS的价值。方法用放射免疫法(IRMA)和化学发光法(CLIA)分别测定275例血清PSA2~4ng/ml的前列腺疾病患者血清中的FT和f/tPSA、T水平,且均以直肠超声引导下TRUS为确诊标准,并用受试者工作特征曲线确定诊断的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比和95%可信区间。结果275例患者中检出前列腺癌(PCa)44例,检出率是16%,PCa组血清f/tPSA比值、T和FT水平[分别为0·19±0·02、(9·32±5·21)nmol/L、(27·20±10·23)pmol/L]均明显低于非前列腺癌组[分别为0·24±0·05、(17·01±8·12)nmol/L、(46·71±13·27)pmol/L,P<0·001]。PCa组中f/tPSA、FT和T在ROC曲线下的面积(AUC)分别为0·680、0·713、0·547,f/tPSA和FT联合应用的AUC为0·851。经ROC曲线分析,f/tPSA0·19和FT27·20pmol/L联合应用的活检临界值,敏感度和特异度均可达84%,阳性预测值50%,阴性预测值96%,阳性似然比5·25和阴性似然比0·19。f/tPSA、FT的单侧95%可信区间分别为0·19(0·19和0·20)、27·20(24·61和29·79pmol/L)pmol/L。结论在PSA为2~4ng/ml的前列腺疾病患者中,血清f/tPSA与FT联合测定,可提示哪些患者需要进行前列腺TRUS,并可提高PCa早期检出率。
Objective To investigate the serum free / total prostate specific antigen (f / tPSA) ratio, testosterone (T) and free testosterone (FT) prostate puncture biopsy (TRUS) threshold and its effect on PSA2 ~ 4ng / Prostate TRUS value. Methods The levels of FT and f / tPSA, T in sera of 275 patients with PSA2 ~ 4ng / ml prostate disease were determined by radioimmunoassay (IRMA) and chemiluminescence (CLIA) The diagnostic criteria, diagnostic sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and 95% confidence interval were determined using the receiver operating characteristic curve. Results Among the 275 patients, 44 cases were diagnosed as prostate cancer (PCa), the detection rate was 16%. The serum f / tPSA ratio, T and FT levels in PCa group were 0.19 ± 0.02 and 9.32 ± 5 · 21) nmol / L, (27 · 20 ± 10 · 23) pmol / L] were significantly lower than those in non-prostate cancer group [0 · 24 ± 0 · 05 and (17 · 01 ± 8 · 12) nmol / L, (46.71 ± 13.27) pmol / L, P <0.001. The area under the ROC curve of f / tPSA, FT and T in PCa group were0.680,0.713,0.547, respectively. The AUC of f / tPSA and FT combination was0.851. The ROC curve analysis, f / tPSA0.19 and FT27 · 20pmol / L biopsy critical value, the sensitivity and specificity of up to 84%, the positive predictive value of 50%, the negative predictive value of 96%, positive likelihood ratio 5.25 and negative likelihood ratio of 0.19. The unilateral 95% confidence intervals for f / tPSA and FT were 0.19 (0.19 and 0.20) and 27.20 (24.61 and 29.99 pmol / L), respectively. Conclusion The combination of serum f / tPSA and FT in patients with prostatic diseases with PSA of 2 ~ 4ng / ml can indicate which patients need TRUS in prostate and improve the early detection rate of PCa.