血清TPSA与F/T检测在前列腺良、恶性病变诊断中的价值及其影响因素

Value of serum total PSA and the ratio of free to total PSA in discriminating the benign and malignant prostatic disease and its influential factors

目的:探讨血清总前列腺特异抗原(TPSA)、游离前列腺特异抗原(FPSA)检测及其比值(F/T)在BPH及前列腺癌(PCa)诊断中的应用价值,并观察各种因素对BPH患者TPSA值变化的影响。方法:对138例BPH患者及35例PCa患者血清TPSA、F/T的差异进行比较;另观察几种因素对298例BPH患者的影响作用。结果:总体比较两组间TPSA及F/T均有统计学意义;而在灰区(4μg/L<TPSA≤10μg/L),两组间TPSA差异无统计学意义,而只有F/T比值具有统计学意义(P<0. 01 );将临界值定为0. 15时,敏感性和特异性分别为85. 72%和77. 53%。在298例BPH患者中,年龄、前列腺大小、尿潴留、并发感染、结石等因素均对TPSA值有显著影响。结论:血清TPSA值测定仍为前列腺癌的重要诊断手段。但F/T值检测能更准确的鉴别位于灰区的病变性质。在TPSA异常增高的前列腺病变的诊断和鉴别诊断中应充分考虑各种影响因素。

Objective:To study the value of serum total PSA and the ratio of free to total PSA (F/T) in discriminating the benign and malignant prostatic disease and the influential factors to change the total PSA in patients benign prostatic hyperplasia (BPH).Methods:TPSA and F/T of 138 cases of BPH and 35 cases of prostatic cancer (PCa) were compared and the influential factor were studied in 298 cases of BPH.Results:The comparison of TPSA and F/T between total of the two kinds of diseases have statistical significance. But when TPSA were in the overlap (4~10 μg/L), only the comparison of F/T have statistical significance (P< 0.01). While the critical value of F/T was determined as 0.15, the sensitivity and specificity were 85.72% and 77.53% respectively. And in the 298 cases of BPH, age, size of prostate, urinary retention, infection and calculus have dramatic influence on TPSA.Conclusions:The determination of TPSA was the important method in diagnosis of prostate cancer. But in the overlap, F/T has more important role in discriminating the benign and malignant prostatic disease. Additionally, a few kinds of influential factors should be considered in dignosis of prostatic diseases with high TPSA.