核素骨显像和血清PSA、ALP检测在前列腺癌骨转移诊断中的价值

The Application of Radionuclide Bone Scintigraphy,Serum PSA and ALP Measurement in Diagnosis of Bone Metastasis in Prostate Cancer Patients

目的探讨核素骨显像和血清前列腺特异抗原(PSA)、碱性磷酸酶(ALP)测定对前列腺癌骨转移诊断的价值。方法对37例前列腺癌患者的核素骨显像结果、血清PSA和ALP结果进行回顾性研究;并对骨转移程度与血清PSA水平和ALP值进行相关分析。结果前列腺癌骨转移发生率为70.3%(26/37),最多见的转移部位为脊柱和骨盆。治疗前18例骨转移患者血清PSA值均>20 ng/ml,与骨转移阴性组有显著差异(P<0.001);对治疗后患者,血清PSA以4 ng/ml作为界值时骨转移阳性组和阴性组无显著差异(P>0.05),而以0.4 ng/ml作为界值时差异有显著性(P<0.05)。ROC曲线分析表明,治疗前血清PSA和ALP曲线下包围的面积分别为0.772和0.923;治疗后PSA和ALP曲线下包围的面积分别为0.885和0.769。相关分析显示,ALP值与骨转移等级之间有较好的直线相关关系(r=0.752,P<0.01);治疗前和治疗后PSA水平与骨转移等级间亦存在正相关关系(r=0.508,P<0.01;r=0.515,P<0.05)。结论核素骨显像仍然是目前诊断前列癌骨转移的主要方法;初诊为前列腺癌的患者,当PSA≥20 ng/ml时,应常规进行骨显像的检查,对治疗后的患者,一旦发现PSA≥0.4 ng/ml,应行骨显像检查;治疗前ALP对骨转移的诊断效能高于PSA,其升高的程度与骨转移的严重程度相关。

Objective To evaluate the clinical value of radionuclide bone scintigraphy, serum prostate-specific antigen （PSA） and alkaline pbosphatase （ALP） measurement in the diagnosis of bone metastasis（BM） in prostate cancer patients. Methods The results of bone scans, serum PSA and ALP levels were reviewed in 37 patients with prostate cancer. Correlation analysis was performed between PSA, ALP levels and BM grade. Results The incidence rate of osseous metastasis was 70.3% （26/37）, the most common involved parts were spine and pelvis. The serum PSA level in 18 untreated patients with BM was all 〉20 ng/ml, which was significantly different with those in 9 untreated patients without BM（NBM）（P 〈 0.01）. For treated patients, there was 11o significant difference between BM and NBM patients when the cutoff value is 4ng/ml（P 〉 0.05）, but significant difference could be received when the cutoff value is 0.4 ng/ml（P 〉0.05）. There was a positive correlation between serum ALP levels and BM degree（ r = 0. 752, P = 0.01）. The levels of PSA in untreated and treated patients also had positive correlation with BM grade （r = 0. 508, P = 0.01; r = 0. 515, P =0.05）. Conclusion Radionudide bone scintigraphy is major method in diagnosis of bone metastasis in prostate cancer patients currently. The levels of PSA 〉20 ng/ml in Patients with newly diagnosed and untreated prostate cancer should undergo bone scintigraphy. For those treated patients, bone scintigraphy should be performed when the PSA is ≥0.4 ng/ml. The diagnostic efficacy of ALP is better than that of PSA in untreated patients. The level of serum ALP is also correlates with the degree of BM.