骨显像联合碱性磷酸酶诊断159例前列腺癌骨转移

Bone Scanning Combined with Bone Alkaline Phosphatase Measurement for Diagnosis of Osseous Metastases in 159 Cases with Prostate Cancer

[目的]探讨骨型碱性磷酸酶(B鄄AKP)对前列腺癌骨转移的诊断价值及与骨显像的关系,弥补骨显像诊断骨转移的不足。[方法]对159例前列腺癌进行骨显像,并测定B鄄AKP。根据骨显像将病人分成骨转移组与无骨转移组,B鄄AKP在两组间的比较采用t检验。按病灶多少将骨显像分0～3级,各级间B鄄AKP比较采用t检验。B鄄AKP值与骨病灶数目间进行相关分析。[结果]①159例病人中,骨显像诊断骨转移114例,10例假阳性,漏诊3例,诊断灵敏度97.2%(104/107),假阳性率19.2%(10/52)。②B鄄AKP诊断骨转移的灵敏度为83.2%,特异性50.0%。③B鄄AKP在骨转移组为(26.3±15.6)μg/L,无骨转移组为(16.9±8.7)μg/L,两组差异有显著性(t=4.045,P<0.001)。单发热区者7例,B鄄AKP值为(19.7±4.1)μg/L,4例单发冷区病人为(13.2±3.2)μg/L,两者差异有显著性(t=2.711,P<0.05)。④B鄄AKP值与骨转移病灶数目间呈正相关(相关系数r=0.751,P<0.01)。[结论]B鄄AKP与骨显像有很好的一致性。诊断前列腺癌骨转移,应首选骨显像。

To investigate the diagnostic value of bone alkaline phosphatase(B-AKP) measurement on osseous metastases in patients with prostate cancer, and the relationship between bone scanning and B-AKP in serum. Bone scanning and B-AKP measurement were performed in 159 cases with prostate cancer. According to bone imaging, the patients were divided into bone metastases group(BM) and non-bone metastases group(NBM). B-AKP was compared between BM group and NBM group by t-test. According to the number of osseous lesions on bone imaging, the patients were divided into grade 0~3. B-AKP was compared between groups with different grade(t-test). Correlation analysis was performed between B-AKP level and the number of osseous lesions. Among 159 cases, 114 cases with osseous metastases were found by bone scanning; 10 cases, false positive; 3 cases, missed-diagnose. The sensitivity of bone scanning was 97.2%(104/107) and the false positive rate was 19.2%(10/52). The sensitivity and specificity of B-AKP measurement were 83.2% and 50.0%, respectively. B-AKP was (26.3±15.6)μg/L in BM group and (16.9±8.7)μg/L in NBM group. There was significant difference in the two groups(t=4.045, P<0.001). B-AKP was (19.7±4.1)μg/L in 7 cases with single hot spot and (13.2±3.2)μg/L in 4 cases with single cold spot. There was difference in these two groups (t=2.711, P<0.05). There was positive correlation between B-AKP level and the number of osseous lesions(r=0.751, P<0.01). [Conclusions] There is high accordance between B-AKP level and bone imaging. To diagnose osseous metastases for patients with prostate cancer, bone scanning is the first choice.