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目的:探讨在总前列腺特异性抗原(tPSA)≥10μg/L的情况下,游离PSA(fPSA)/tPSA对前列腺癌(PCa)与前列腺增生(BPH)的鉴别诊断价值。方法:回顾性分析2011年12月1日~2014年12月1日期间就诊于我院行前列腺穿刺活检术及前列腺相关手术,术前血清tPSA≥10μg/L且依前列腺病理检查报告明确诊断为PCa和BPH患者共计361例,应用逻辑回归分析f/tPSA在PCa与BPH鉴别诊断中的价值,利用受试者工作特征曲线(ROC)对比分析f/tPSA在PCa与BPH鉴别诊断中的特异性和敏感性。结果:在所纳入的361例患者中,PCa患者155例(42.9%),BPH患者206例(57.1%)。在tPSA处于10~100μg/L时,PCa和BPH患者中的f/tPSA中位数分别为0.09和0.15(P<0.001);在tPSA处于10~40μg/L时,PCa和BPH患者中的f/tPSA中位数分别为0.10和0.16(P<0.001)。应用逻辑回归分析,当tPSA处于10~100μg/L时,联合应用f/tPSA分别使tPSA或fPSA单独诊断PCa时的准确性提高3.4%(P<0.019)及24.6%(P<0.001),当tPSA处于10~40μg/L时,分别提高了5.0%(P<0.019)及17.1%(P<0.001)。应用ROC曲线分析,在tPSA处于10~40μg/L的患者中,当f/tPSA、tPSA、fPSA诊断PCa的敏感性均达到80.2%且f/tPSA的临界值设定为0.145时,f/tPSA相较tPSA、fPSA诊断PCa的特异性分别提高7.2%、29.0%。结论:在血清tPSA处于10~100μg/L的患者中,f/tPSA对于PCa与BPH的鉴别诊断仍具有重要意义,尤其是在血清tPSA处于10~40μg/L的患者中,可明显提高诊断PCa的准确性,进一步减少不必要的穿刺活检。
Objective: To investigate the differential diagnostic value of free PSA (fPSA) / tPSA in the diagnosis of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) with total prostate specific antigen (tPSA) ≥10 μg / L. Methods: Retrospective analysis of prostate biopsy and prostate-related surgery in our hospital from December 1, 2011 to December 1, 2014, preoperative serum tPSA ≥ 10μg / L and diagnosed according to the report of prostate pathology A total of 361 patients with PCa and BPH were enrolled in this study. Logistic regression was used to analyze the value of f / tPSA in the differential diagnosis of PCa and BPH. The specificity of f / tPSA in differential diagnosis of PCa and BPH was analyzed by receiver operating characteristic curve (ROC) And sensitivity. Results: Of the 361 patients enrolled, 155 (42.9%) had PCa and 206 (57.1%) had BPH. The f / tPSA median in patients with PCa and BPH was 0.09 and 0.15, respectively, at the tPSA of 10-100 μg / L (p <0.001). At the tPSA of 10-40 μg / L, the median f / tPSA median was 0.10 and 0.16 (P <0.001), respectively. Logistic regression analysis showed that when tPSA was in the range of 10-100 μg / L, the combined use of f / tPSA increased the accuracy of tPAA or fPSA alone in diagnosing PCa by 3.4% (P <0.019) and 24.6% (P <0.001), respectively The levels of tPSA increased by 5.0% (P <0.019) and 17.1% (P <0.001) by 10-40 μg / L, respectively. Using ROC curve analysis, when the sensitivity of f / tPSA, tPSA, fPSA to diagnose PCa reached 80.2% and the critical value of f / tPSA was set to 0.145 in patients with tPSA between 10 and 40 μg / L, f / tPSA Compared with tPSA, the specificity of fPSA in diagnosing PCa increased by 7.2% and 29.0% respectively. Conclusion: f / tPSA is of great significance in the differential diagnosis of PCa and BPH in patients with serum tPSA between 10 and 100 μg / L, especially in patients with serum tPSA between 10 and 40 μg / L, which can significantly improve the diagnosis of PCa The accuracy of further reducing unnecessary needle biopsy.