前列腺液中B7-H3分子表达对t-PSA灰区内炎性PSA升高的鉴别诊断价值

The value of B7-H3 expression in expressed prostatic secretions in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone

目的探讨前列腺液（EPS）中B7-H3分子对血清t—PSA灰区（4～10ng／ml）内炎性PSA升高患者的鉴别诊断价值。方法选择2009年12月至2010年4月收治的全部慢性前列腺炎（CP）患者和t—PSA灰区内行前列腺穿刺活检患者共116例，年龄19—80岁，平均40岁。CP91例，年龄19～49岁，平均31岁。其中慢性细菌性前列腺炎（II型）11例、慢性炎症性非细菌前列腺炎（IIIA型）26例、慢性非炎症性非细菌前列腺炎（IIIB型）54例。t-PSA灰区内接受经直肠超声引导下前列腺穿刺活检患者25例，年龄62—80岁，平均71岁，t-PSA（7．21±2．60）ng／ml。其中穿刺病理结果阳性5例，Gleason评分6分2例、7分2例、8分1例；阴性20例，其中伴炎症细胞浸润11例。采用经直肠按摩法提取EPS。酶联免疫吸附法检测各组EPSB7-H3水平。健康男性对照11例，年龄24～46岁，平均30岁。既往无泌尿系不适症状及手术史。结果对照组、II型组、IIIA型组、IIIB型组EPS中B7—H3水平依次为（49．81±11．54）、（19．33±13．90）、（17．67±15．76）、（25．14±13．44）ng／ml，穿刺阳性组、阴性不伴炎症组、阴性伴炎症组分别为（26．30±16．32）、（30．23±18．42）、（10．11±5．42）ng／ml。CP各组EPSB7-H3水平均低于对照组，差异有统计学意义（P〈0．01）。II型组和IIIA型组间差异无统计学意义（P〉0．05），但均显著低于IIIB型组，差异有统计学意义（P〈0．05）。穿刺阴性伴炎症组EPS中B7-H3水平与II型组、IIIA型组比较差异无统计学意义（P〉0．05），但显著低于穿刺阳性组及阴性不伴炎症组，差异有统计学意义（P〈0．05）。EPSB7-H3表达检测在t—PSA灰区内诊断炎性PSA升高患者的ROC曲线下面积为0．883（P=0．001），当EPSB7-H3值≤16．24ng／ml时，诊断敏感性为78．6％，特异性为81．8％。结论EPSB7-H3表达检测可能成为t-PSA灰区内鉴别诊断炎性PSA升高的新指标，从而减少不必要的前列腺穿刺活检。

Objective To investigate the value of BT-H3 in expressed prostatic secretions （EPS） in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone （4 -10 ng/ml）. Methods One hundred and sixteen patients from the ages of 19 to 80 years （mean, 40 years） were studied. In the group there were 91 chronic prostatitis （CP） patients （mean age 31 years, 19 -49 years） , including 11 chronic bacterial prostatitis （type II） patients, 26 inflammatory nonbacterial prostatitis （IIIA） patients and 54 noninflammatory nonbaeterial prostatitis （IIIB） patients. Transrectal ultrsound guided prostate biopsy was performed on 25 patients （ mean age 71 years, 62 - 80 years） with t-PSA in gray zone （7.21 ± 2.60 ng/ml）. Five had positive results, Gleason score was 6 in two cases, 7 in two cases and 8 in one case. Twenty patients had negative results, of whom 11 patients had inflammatory cell infiltration. EPS was collected by transrectal massage, and Enzyme-linked immunosorbent assays （ELISA） were performed for B7-H3 detection. In addition, 11 normal male controls with a mean age of 30 years （24 -46 years） were recruited into the study. Volunteers were excluded if they had a history of genitourinary symptoms or surgery. Results The EPS B7-H3 levels of controls, II, IIIA, IIIB groups were 49.81 ± 11.54, 19.33 ± 13.90, 17.67±15.76, 25. 14 ± 13.44 ng/ml, respectively. The levels of EPS B7-H3 in positive biopsy, nonin- flammatory negative biopsy and inflammatory negative biopsy groups were 26.30 ±16.32, 30.23 ± 18.42, 10.11 ± 5.42 ng/ml, respectively. The highest levels were found in the control group （ P 〈 0.01 ）. Compared to the IIIB, B7-H3 levels in II and IIIA groups were significantly lower （ P 〈 0.05 ）. There was no significantly difference between II and IIIA groups （ P 〉 0.05）. The EPS B7-H3 levels in the inflammatory negative biopsy group were statistically lower than in positive biopsy and noninflammatory biopsy groups （P 〈 0.05）. But no significant differences were found among inflammatory negative biopsy, II and IIIA groups （P 〉 0.05 ）. Receiver operating curve （ AUC = 0. 883, P = 0. 001 ） utilizing EPS B7-H3 levels ≤ 16.24 ng/ml identified patients with inflammatory elevation of PSA with a sensitivity of 78.6% and a speci- ficity of 81.8% from patients with t-PSA in gray zone. Conclusion The EPS B7-H3 detection provides a new way for differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone resulting in a reduction of unnecessary prostate biopsy.