前列腺酸性磷酸酶在前列腺癌骨转移中的诊断价值

Evaluation of Diagnosis Value of Acidic Phosphatase Prostate in Prostate Cancer with Bone Metastases

目的 运用ROC曲线评价前列腺酸性磷酸酶（PAP）在诊断前列腺癌骨转移中的应用价值.方法 参照〈外科学〉（第7版）,根据病理组织学检查,并结合病史及PSA水平,收集前列腺疾病106例,分为三组：①前列腺癌骨转移组,36例;②前列腺癌未转移组,20例;③前列腺良性疾病组,50例.另设健康对照组50名.采用化学发光法对四组人群血清中的PAP进行定量检测.比较四组结果间的差异,评估PAP在前列腺癌骨转移中的诊断价值.结果 前列腺癌骨转移组为23.497（3.553-100.000）ng/ml,高于未转移组的3.638（0.361-12.694）ng/ml,前列腺良性疾病组的1.955（0.721-4.448）ng/ml和健康对照组的1.350（0.130-1.780）ng/ml,差异有统计学意义（H=104.473,P=0.000）,对实验数据进行ROC曲线分析显示,PAP诊断前列腺癌骨转移组的ROC曲线下面积（AUC）为0.940,诊断临界值为9.528 ng/ml,其诊断敏感度为80.55%,特异度为95.00%,阳性预期值（PV＋）为96.67%,阴性预期值（PV-）为73.08%,准确率为85.71%,Youden值为75.60%.结论 PAP在诊断前列腺癌骨转移中具有较好的敏感性和较高的特异性,可作为前列腺癌骨转移诊断以及与其他前列腺疾病的鉴别诊断指标.

Objective To evaluate the diagnostic value of prostatic acid phosphatase （PAP） in prostate cancer with bone metastases by ROC analysis. Methods According to ＂Surgery＂ （seventh Edition） and the diagnostic criteria of Prostate cancer, also with the histopathologic examination, patients＇ medical history and level of PSA,seleeted 106 patients with prostate disease and divided them into three groups= 29 prostate cancer patients with bone metastasis, 16 prostate cancer patients without bone metastasis and 50 patients with benign prostate disease. Meanwhile, 50 healthy individuals were selected as a control group. PAP was detected by chemiluminescence immunoassay（CLIA）. Compared the differences between the four groups and assess the diagnosis value of PAP in prostate cancer with bone metastases. Results The results of PAP in pros- tate cancer with bone metastasis group [23. 497（3. 553-100. 000）ng/ml] were higher than those of prostate cancer without bone metastasis group [3. 638（0. 361-12. 694）ng/m13,with benign prostate disease group [1. 955（0. 721-4. 448）ng/ml] and control group [-1. 350（0. 130-1. 780）ng/ml]. There was statistically significant difference （H= 104. 473, P= 0. 000）. ROC curve analysis showed that the area under curve was 0. 940,the critical value of diagnosis was 9. 528 ng/ml. The sensi- tivity,specificity, predicted value of positive, predicted value of negtive, crude accuracy and value Youden were 80. 55 %, 95.00 %, 95.65 %,73.08 %, 85.71% and 75.60 % respectively. Conclusion PAP can be used as bone metastasis of prostate cancer diagnosis important diagnostic identification index for its high sensitivity and specificity.