尿肌氨酸水平对前列腺癌诊断及预后判断的应用价值

Diagnostic and prognostic value of urinary sarcosine for prostatic cancer

目的探讨尿肌氨酸水平对前列腺癌（PCa）的诊断和病情判断方面的应用价值。方法选取我院泌尿外科住院的经前列腺穿刺活检确诊的PCa患者16例，年龄65±89（68．4±10．2）岁。采集PCa患者的血标本和尿标本，然后用同位素稀释液相色谱质谱法检测其血、尿肌氨酸水平，电化学发光法检测血清前列腺特异抗原（PSA）水平，并根据其Gleason评分及是否骨转移进行统计学分析。结果PCa伴有骨转移患者（n=9）与无转移患者（n=7）血清总前列腺持异抗原（TPSA）水平含量差异具有统计学意义[（203．95±169．68）w（35．53±35．77）pg／L，P〈O．05]，而游离前列腺持异抗原（fPSA）水平在两组间差异无统计学意义[（14．41±11．84）VS（3．92±4．15）μg/L]。PCa伴有骨转移患者的尿液中肌氨酸含量明显高于不伴发骨转移患者[（1277．67±432．78）VS（494．71±211．35）μg／L，P=O．018]。按照Pca病理结果分级，血肌氨酸水平在各个Gleason评分组中差异无统计学意义；而尿肌氨酸含量差异具有统计学意义（P〈0．015），且Gleason评分越高，尿液中肌氨酸含量也越高。PCa患者的尿肌氨酸水平与Gleason评分及是否骨转移具有相关性，且组间差异具有统计学意义（P〈0．05）。结论尿肌氨酸有可能成为用于诊断PCa的肿瘤标志物，并具有一定的判断病情的应用价值。

Objective To investigate the value of the urinary sarcosine in the diagnosis and prognosis of prostate cancer（PCa）. Methods A total of 16 PCa patients, with age ranging from 65 to 89（68.4± 10.2）years, diagnosed by prostate biopsy in our department from May 2009 to May 2011, were enrolled in this study. Their blood and urinary samples were collected for detection of sarcosine level by isotope dilution-liquid chromatography mass spectrometry （LC/MS）. Electrochemiluminescence assay was used for the detection of serum level of prostate specific antigen （PSA）. The results were statistically analyzed with their Gleason scores and with bone metastasis. Results There was significant difference in the total PSA（TPSA） level between the PCa patients with bone metastases In = 9, （203.95 ± 169.68）ktg/L] and without In = 7, （35.53 ± 35.77）μg/L, P〈 0.05], while no difference was found in free PSA （fPSA） level between them [（14.41 ±11.84） vs （3.92 ±4.15）μg/L, P〉 0.05]. The urinary sarcosine level was significantly higher in the PCa patients with bone metastasis than those without [（1277.67± 432.78） vs （494.71 ± 211.35） μg/L, P= 0.018]. There was no significant difference in the serum sarcosine level between different pathological Gleason scores, but urinary sarcosine level was significantly elevated with the increase of Gleason score（P 〉 0.05）. Urinary sarcosin level was correlated with Gleason score and bone metastasis（P 〈 0.05）. Conelusion Urinary sarcosine might be used as a useful tumor marker for the diagnosis and prognosis of PCa.