TPSA,FPSA,F/TPSA和PAP联检在前列腺癌诊断中的意义

Significance of Combined Determination of Serum TPSA, FPSA, F/TPSA and PAP for Diagnosis of Prostatic Cancer

目的 :研究各年龄组正常人血清总前列腺特异性抗原 (TPSA)、游离前列腺特异性抗原 (FPSA)、前列腺酸性磷酸酶 (PAP)和F/TPSA比值的正常值范围以及与年龄的相关性 ,并探讨其联合应用在良性前列腺增生(BPH)和前列腺癌 (PC)鉴别诊断中的价值。方法 :采用酶放大化学发光法测定 89名正常志愿者、35例PC患者和 82例BPH患者血清TPSA、FPSA和PAP的水平 ,并计算F/TPSA的比值。结果 :4 1岁～ 88岁的正常人血清TPSA和FPSA水平与年龄有显著正相关性 (TPSA/年龄 :r=0 .4 4～ 0 .4 5 ,P <0 .0 1 ;FPSA/年龄 :r =0 .4 9～ 0 .5 1 ,P<0 .0 1 ) ;PC组和BPH组血清TPSA、FPSA和PAP水平明显高于正常对照组 (P <0 .0 1 ) ,而PC组F/TPSA比值则明显低于BPH组和正常人组 (P <0 .0 1 )。F/TPSA比值的分段研究显示 ,在TPSA轻、中度升高时 ,F/TPSA <0 .1提示PC可能性较大 (88 2 % ) ,而F/TPSA >0 .2 5时 ,表明PC可能性很小 (4 0 % )。结论 :4 0岁以上正常男性血清TPSA和FPSA水平随年龄升高而增加 ,并与年龄呈明显的正相关 ;TPSA。

Objective To study the age-specific reference range of serum levels of total prostatic specific antigen (TPSA), free prostatic specific antigen (FPSA), F/TPSA ratio and prostatic acid phosphatase (PAP) in healthy men and to evaluate the usefulness of their combined determination in the differential diagnosis of benign prostatic hyperplasia (BPH) from prostatic cancer (PC). Methods Serum TPSA, FPSA and PAP levels were measured with chemiluminescence enzyme immunoassay (CLEIA) in 35 patients with PC, 82 patients with BPH and 89 controls of various age groups (21～40 n=21 , 41～60 n=30 , 61～88 n=38 ). F/TPSA ratio was calculated from the data. Results Serum TPSA and FPSA levels were higher in the elderly Subjects ,being significantly higher in the 61～88 age group than those in the other two age groups. Both levels were positively correlated to age in the age groups of 41～60 and 61～88 (TPSA/age: r=0.44～0.45 P <0.01; FPSA/age: r=0.49～0.51, P<0.01 ). Serum TPSA, FPSA and PAP levels were significantly higher in patients with PC and patients with BPH than those in the controls ( P <0.01). F/TPSA ratio in patients with PC was lower than that in BPH than those in the controls ( P <0.01). F/TPSA ratio in patients with PC was lower than that in BPH patients and controls ( P <0.01). With serum TPSA levels moderately increased (4～10μg/L) and F/TPSA ratio≤0.10, the probability of PC was high (88.2%); with F/TPSA ratio≥0.25, the probability of PC was very low (4%). Conclusion Both serum TPSA and FPSA increased with age in the controls from 41 yr on and there were positive correlations. Combined determination of TPSA, FPSA and PAP could enhance the sensitivity and specificity for diagnosis of BPH and PC.