相关临床操作对血清PSA、FPSA影响的研究

Influence of clinical procedures on serum PSA and FPSA concentration

目的：探讨相关临床操作对血清前列腺特异抗原（PSA）、游离PSA（FPSA）的影响。方法：对103例患者进行前瞻性研究，了解直肠指诊、留置尿管、膀胱镜及输尿管镜操作、前列腺穿刺活检、TURP和开放性前列腺手术等相关因素对血清PSA、FPSA的影响程度及时间。结果：直肠指诊后，PSA改变（0．18±1．36）ng／ml，FPSA改变（0±0．23）ng／ml，差异无统计学意义（P〉0．05）。留置尿管后，PSA、FPSA值分别升高1．6倍和1．23倍（P〈0．05）。膀胱镜及输尿管镜操作后，PSA、FPSA值分别升高73％和42％（P〈0．01和〈0．05）。前列腺穿刺活检后，PSA、FPSA值分别升高1．04倍和1．74倍（P〈0．01和〈0．05）。TURP术后，PSA、FPSA值分别升高2．23倍和2．82倍（P〈0．01）。开放性前列腺手术后，PSA值升高2．32倍（P〈0．05），FPSA值升高2．28倍（P〉0.05）。各组F／T均值变化范围为-7％～27％，差异均无统计学意义（P〉0．05）。4周后测定PSA、FPSA、F／T值，与操作前相比差异无统计学意义，但前列腺切除术后PSA、FPSA有下降趋势。结论：本研究认为直肠指诊对血清PSA和FPSA值的改变无影响。留置尿管、膀胱镜及输尿管镜操作、前列腺穿刺活检、TURP和开放性前列腺手术等操作均可引起血清PSA和FPSA值显著改变，重复血清PSA和FPSA的测定在这些操作后4周进行较为妥当。

Objective：To evaluate the influence of clinical procedures on serum PSA and FPSA concentration. Methods：A total of 138 patients were studied prospectively, the effects of digital rectal examination （DRE）, indwelling catheter, cystoscopy （rigid）, prostate needle biopsy and prostatectomy on serum PSA and FPSA concentration were observed. Results：The PSA and FPSA changing caused by DRE was 0. 18± 1.36 ng/ml and 0±0.23 ng/ml respectively, neither was significant （P〉0.05）. Indwelling catheter caused an 1.6-fold and 1.23-fold increase on PSA and FPSA （P〈0. 05） Cystoscopy had the effects of 73% and 42% elevation on PSA （P〈0. 01） and FPSA （P〈0.05）. The PSA and FPSA concentration had an 1.04-fold and 1.74-fold increase after prostate biopsy （P〈0.01, 0.05）, and had more remarkable elevation （2.23-fold and 2.82-fold, P〈0.01） after TURP. Prostatectomy by open surgery caused an 2.32-fold increase on PSA （P〈0.05） and 2.28-fold increase on FPSA （P〉0.05）. F/T values changed from -7% to 27% in all cases, but none of the change was significant. The serum PSA and FPSA concentration returned to the base level 4 weeks after the procedures, although some of the values seemed to be lowered by prostatectomy. Conclusions：DRE had no significant effects on serum PSA and FPSA concentration. PSA and FPSA concentration increased significantly after indwelling catheter, cystoscopy, prostate biopsy and prostatectomy. We recommend that it is prudent to wait for 4 weeks after these procedures before measuring the serum PSA and FPSA value.