f-PSA/t-PSA和c-PSA/t-PSA比值对于前列腺癌与良性前列腺增生鉴别诊断意义的多中心研究

Multicentre study of f-PSA/t-PSA and c-PSA/t-PSA about their value on differential diagnosis between prostate cancer and benign prostate hyperplasia

目的探讨f-PSA/t-PSA和c-PSA/t-PSA比值在前列腺癌(PCa)与良性前列腺增生(BPH)鉴别诊断中的作用。方法对5家医院107例PCa患者和319例BPH患者的血清总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA)、结合前列腺特异性抗原(c-PSA)进行检测,计算f-PSA/t-PSA和c-PSA/t-PSA,对f-PSA/t-PSA和c-PSA/t-PSA在鉴别PCa和BPH中的作用进行比较。结果血清t-PSA处于4～20ng/ml区间时,以f-PSA/t-PSA<0.16作为诊断PCa的标准,诊断PCa的敏感度、特异度、阳性预测值和阴性预测值分别是89.0%、78.0%、60.7%和94.6%,以c-PSA/t-PSA>0.84作为诊断PCa的标准时,分别是91.8%、81.3%、66.3%和96.1%。f-PSA/t-PSA<0.16和c-PSA/t-PSA>0.84两项标准诊断PCa的敏感度和阴性预测值无统计学差异(P>0.05),但c-PSA/ t-PSA>0.84诊断PCa其特异度和阳性预测值显著高于f-PSA/t-PSA<0.16的标准(P<0.05)。结论血清t-PSA在4～20ng/ml区间时,f-PSA/t-PSA<0.16和c-PSA/t-PSA>0.84都可以为PCa的诊断提供帮助,但c-PSA/ t-PSA>0.84诊断PCa的特异度和阳性预测值好于f-PSA/t-PSA<0.16的标准。

Objective To study the value of f-PSA/t-PSA and c-PSA/t-PSA in differential diagnosis between prostate cancer （PCa） and benign prostate hyperplasia （BPH）. Methods The level of serum total prostate specific antigen （t-PSA）, free prostate specific antigen （f-PSA）, complexed prostate specific antigen （c-PSA） were detected respectively in 107 PCa patients and 319 BPH patients from 5 hospitals, then f-PSA/c-PSA and c-PSA/t-PSA were calculated. The value of f-PSA/c-PSA and c-PSA/t-PSA in differential diagnosisbetween PCa and BPH were assessed. Results When file range of serum t-PSA was 4-20ng/ml, the clinical sensitivity, specificity, positive predictive value and negative predictive value of f-PSA/t-PSA〈0.16 for diagnosis of PCa were 89.0%, 78.0%, 60.7% and 94.6 % respectively. The clinical sensitivity, clinical specificity, positive predictive value and negative predictive value of c-PSA/t-PSA〉0.84 were 91.8%, 81.3%, 66.3% and 96.1% respectively. The sensitivity and negative predictive value of f-PSA/t-PSA〈0.16 and c-PSA/t-PSA〉0.84 were not significant difference for diagnosis of PCa （P〉0.05）. But the specificity and positive predictive value of c-PSA/t-PSA〉0.84 were significantly higher than that of f-PSA/t-PSA〈0.16 （P〈0.05）. Conclusion When the level of serum t-PSA ranged from 4 to 20ng/ml, all of f-PSA/t-PSA〈0.16 and c-PSA/ t-PSA〉0.84 might be good biomarkers in diagnosis of PCa. The specificity and positive predictive value of c-PSA/t-PSA〉0.84 were better than that of f-PSA/t-PSA〈0.16 in the diagnosis of PCa.