血清BSP水平联合PSADT检测在前列腺癌骨转移早期诊断中的价值

Application Value of Serum BSP and PSADT Detection in Early Diagnosis of Bone Metastases of Prostate Cancer

目的探讨骨代谢生化指标骨唾液酸蛋白(bone sialoprotein,BSP)联合前列腺特异性抗原倍增时间(prostate-specific antigen doubling time,PSADT)检测在前列腺癌骨转移临床诊断中的意义。方法选择2009年1月—2011年4月我院收治的前列腺癌患者58例,依据诊断分为转移组(28例)和无骨转移组(30例),取前列腺良性增生患者60例以及60例健康体检人员分别作为增生组和健康对照组。采用视觉模拟疼痛评分(VAS)评价骨痛程度;采用ELISA法检测血清BSP水平;采用电化学免疫发光技术检测血清f-PSA、t-PSA水平,采用倍增公式PSADT=lg(2)[log(PSA2)-log(PSA1)]计算PSADT;采用ROC曲线评价BSP、PSADT及两者联合检测在前列腺癌骨转移诊断中的意义。结果两组患者BSP水平均高于健康对照组和增生组(P<0.05);骨转移组患者血清BSP水平均明显高于无转移组(P<0.05);Pearson’s分析结果显示:前列腺癌骨转移患者的BSP和VAS骨痛评分呈显著正相关(P<0.05);ROC曲线显示,BSP诊断骨转移的敏感度和特异性分别为71.12%和72.8%;PSADT诊断骨转移的敏感度和特异性分别为84.15%和82.96%;BSP联合PSADT在前列腺癌骨转移诊断中的敏感度、特异性、AUC面积分别为91.26%,89.54%,0.932。结论BSP可能是前列腺癌骨转移患者的有效诊断指标;BSP和PSADT联合检测能大大提高前列腺癌骨转移的敏感度和准确性,便于前列腺癌骨转移的早期诊断。

Objective To explore the clinical significance of bone sialoprotein and free prostate specific antigen（PSA）,total prostate-specific antigen testing and prostate-specific antigen doubling time（PSADT） for prostate cancer bone metastases.Methods A total of 58 cases of patients with prostate cancer from January 2009 to April 2011 in our hospital,were divided into 2 groups：bone metastasis（n=28） and non-bone metastasis（n=30）.Sixty benign prostatic hyperplasia patients and 60 normal controls were recruited as hyperplasia group and control group,respectively.The severity of bone pain was evaluated using visual analogue score（VAS）.The serum BSP level was detected by ELISA method.The serum f-PSA,t-PSA level were measured by Electrochemiluminescence immunoassay（ECLIA）.The PSADT was calculated as PSADT=lg（2） / [log（PSA2）-log（PSA1）].Determine the diagnostic sensitivity,specificity,and predictive value and cut-off values of these serum tumor markers by ROC curve.Results The BSP levels of both the two patient groups were higher than that of the control group and the hyperplasia group（P0 05）.The BSP level of bone metastasis group was higher than that of the non-bone metastasis group（P0 05）.Pearson＇s analysis showed that the BSP of bone metastases has a significant positive correlation with VAS pain score（P0.05）.The sensitivity and overall diagnostic efficiency of BSP for determining bone metastasis of prostate cancer is 71.12% and 72.8%.And the sensitivity and overall diagnostic efficiency of PSADT is 84.15% and 82.96%,respectively.When the two tumor markers simultaneity were measured,the specificity,sensitivity and AUC area were 91.26%,89.54% and 0.932,respectively,in the diagnosis of bone metastases of prostate cancer.Conclusion BSP and PSADT are useful markers in diagnosis of bone metastasis of prostate cancer.Combined determination of BSP and PSADT can improve accuracy and positive rate of bone metastasis of prostate cancer significantly.