前列腺特异性抗原与骨标志物对前列腺癌骨转移患者治疗效果的评价

Significance of prostate specific antigen and markers of bone formation and resorption in evaluation of efficacy of bone metastasis treatment in prostate cancer patients

目的探讨前列腺特异性抗原（PSA）与骨形成标志物总碱性磷酸酶（tALP）、骨吸收标志物抗酒石酸酸性磷酸酶5b（TRACP5b）、I型胶原吡啶交联终肽（ICTP）在前列腺癌骨转移患者治疗过程中反映骨代谢变化的意义。方法测定57例老年前列腺癌患者PSA、tALP、TRAcP5b、ICTP血清浓度，采用Pearson相关分析法分析去势治疗持续时间与各指标浓度（In转换后）的相关性。将前列腺癌骨转移患者分成无双膦酸盐组（A组）、稳定前列腺癌骨转移＋双磷酸盐组（B组）与严重前列腺癌骨转移＋双磷酸盐组（C组），比较3组间各标志物血清浓度的差异。结果去势治疗持续时间与PSA呈负相关，与tALP、ICTP及TRACP5b呈正相关，但仅In（TRACP5b浓度）与ln（去势治疗持续时间）具有统计学意义（R=0．421，P〈0．01）；C组与A组比较，PSA、TRACP5b、tALP浓度均升高，其中仅TRACP5b差异有统计学意义（P〈0．05）；C组与B组比较，PSA、tAI，P、1CTP、TRACP5b浓度明显升高，差异均有统计学意义（P〈0．05）。结论在前列腺癌骨转移患者的去势治疗与双磷酸盐治疗过程中，检测PSA与骨吸收形成标志物可起到监测骨代谢的变化作用，其中TRACP5b反应骨代谢变化更灵敏。

Objective To evaluate the significances of prostate specific antigen （PSA）and alkaline phosphatase（ALP）as a marker of bone formation and tartrate resistant acid phosphatase 5b （TRACP5b）and pyridinoline cross-linked carboxy-terminal telopeptide of type I colIagen（ICTP）as markers of bone resorption in predicting therapeutic effect of bone metastasis of prostate cancer patients. Methods Serum levels of PSA, tALP, TRACPSb and ICTP in 57 elderly patients aged 61-90 years with prostate cancer were determined by electrochemiluminescence, colorimetric assay, enzyme linked immunosorbent assays（ELISA）respectively. The correlation between the duration of ADT and the concentrations of each marker index （In-transformed） was analyzed by Pearson correlation analysis. All prostate cancer patients with bone metastasis were divided into group A （patients without bisphosphonates, n = 13）, group B （patients with stable bone metastasis and bisphosphonates, n= 6） and group C （patients with severe bone metastasis and bisphosphonates, n= 8）. The concentration of each bone metabolic marker was compared between the three groups. Results Pearson correlation analysis showed that serum concentrations of PSA, ALP and ICTP had no significant correlations with the duration of ADT, but TRACP5b concentration （In transformed） had a significant positive correlation with the duration of ADT （ln transformed） （R = 0. 421, P〈 0.01）. The concentrations of PSA, TRACP5b and tALP were increased in group C as compared with group A, but only TRACP5b concentration had a significant difference between group A and C （P〈 0.05）. The concentrations of PSA, tALP, ICTP and TRACP5b were significantly increased in group C as compared with group B （all P〈0.05）. Conclusions PSA and bone resorption and formation markers can be excellent monitors of therapeutic effect relating bone metabolism changes during castration and bisphosphonate treatment in prostate cancer patients with bone metastasis, and TRACPSb may be more sensitive.