经直肠前列腺穿刺活组织检查阳性结果分析

Clinical analysis for positive results of transrectal prostate biopsies

目的通过研究前列腺特异性抗原(PSA)的水平来评价与前列腺癌(PCa)的关系。方法采用8针活组织检查(活检)方法,对血清PSA>4μg/L,直肠指诊检查前列腺质地异常、结节,经直肠前列腺超声怀疑前列腺占位病变的328例患者进行经直肠前列腺活检,所得结果进行病理分析。结果良性前列腺增生(BPH)192例,占58.5%;PCa 103例,占31.4%,其中包括前列腺基底细胞癌1例;前列腺炎14例,占4.3%;前列腺上皮内瘤9例,占2.8%;非典型性腺瘤样增生6例,占1.8%;结核2例,占0.6%;平滑肌肉瘤1例,占0.3%;淋巴瘤1例,占0.3%。根据PSA值分5组:≤4μg/L组(B超或直肠指诊有异常),4.1～10.0μg/L组,10.1～20.0μg/L组,20.1～100.0μg/L组,>100.0μg/L组。各组PCa检出率依次为:8.9%、13.3%、23.1%、37.9%和73.2%。各组间阳性率比较,差异有统计学意义(P<0.01),采用相关性分析,各组阳性率与血PSA值呈正相关。结论在PSA水平不高的情况下前列腺肿瘤的检出率也不低,在合理筛选患者的前提下,经直肠前列腺穿刺活检阳性结果与PSA水平高度相关,对于PSA>100.0μg/L的患者,检出阳性率较高。

Objective To analyze the relationship between prostate specific antigen（PSA） level and prostate eaneer（PCa）. Methods Transreetal prostate biopsies with was performed on 328 patients with abnormal prostates on digital rectal examination,with serum PSA〉4μg/L,and transrectal ultrasound results showed suspected abnormalities. Results There were 192 （58.5%） cases of benign prostate hyperplasia（BPH） in these patients. There were 103 eases of PCa （31.4%） ,including 1 ease of prostate basal cell cancer ;14（4.3%） prostatitis; 9（2.8%） cases of prostatic intraepithelial neoplasia（PIN） ; 6 （ 1.8 % ） eases of atypical adenomatous hyperplasia, 2 （0.6%） eases of tuberculosis, 1（0.3 %） cases of leiomyosareoma, 1 （0.3% ） cases of lymphoma. There were 5 groups according to different PSA levels：≤4 μg/L（abnormal ultrasound or anus exam） ,1-10.0 μg/L,10.1-20.0 μg/L,20.1-100.0〉100.0 μg/L groups, and the PCa detection rate of each groups were 8.9 %, 13.3 %, 23.1 %, 37.9 %,73.2 %, with significant different（P〈0.01）. According to the correlation analysis,the positive rate of every group had a positive correlation to the blood PSA level. Conclusion The positive rates are correlated with the level of the PSA. Patients with PSA more than 100 μg/L have higher positive ratios.