良性前列腺增生与前列腺癌患者血清总PSA水平与游离PSA比值的比较

Serum total PSA and the ratio of free to total PSA in patients of benign prostatic hyperplasia and prostate cancer

目的 探讨血清总前列腺特异性抗原 (T PSA)水平及游离PSA比值 (F/T)在良性前列腺增生 (BPH)与前列腺癌 (PCa)鉴别诊断中的作用。 方法 对 10 3例PCa患者及 810例BPH患者T PSA及F/T值的差异进行分析比较。 结果 BPH患者血清T PSA <4、4～及 >10ng/ml者分别占 71.7%、2 2 .1%、6 .2 % ,PCa患者分别为 10 .7%、17.5 %和 71.8% ,两组间差别有极显著性意义 (P<0 .0 0 5 )。当F/T值 <0 .16时 ,两组患者血清T PSA <4及 4～ 10ng/ml的例数差别有极显著性意义 (P <0 .0 0 5 ) ;但T PSA >10ng/ml的患者 ,两组间差别无显著性意义 (0 .1<P <0 .2 5 )。F/T值为0 .16时 ,鉴别前列腺良性病变的特异性为 82 .2 % ,敏感性为 72 .4 %。 结论 约 2 8.0 %的BPH与PCa患者血清T PSA水平存在重叠区域 ;当T PSA <10ng/ml时 ,F/T值对BPH与PCa的鉴别有显著性意义 ,此时 0 .16是较合理的F/T临界值 ;当T PSA >10ng/ml时 。

Objective To compare the serum PSA (T PSA and F/T PSA ratio) between patients of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Methods We studied retrospectively 810 cases of BPH and 103 cases of PCa consecutively from November of 1996 to June of 1999 and compared the differences of T PSA level and F/T ratio between these two kinds of diseases. Results In BPH patients,serum T PSA <4 ng/ml,4～10 ng/ml and >10 ng/ml were 71.7%, 22.1 % and 6.2% respectively while these were 10.7%,17.5% and 71.8% in PCa patients ( P <0.005).When F/T ratio was <0.16,there were significant differences for the component percentages of BPH and PCa cases with the T PSA level <4 or 4～10 ng/ml( P <0.005), whereas there were no differences for those with the T PSA level >10 ng/ml(0.1< P <0.25).When F/T ratio =0.16,its specificity has been 82.2% and its sensitivity 72.4% for distinguishing malignant from benign diseases of the prostate gland. Conclusions There are about 28.0% of BPH and PCa patients with overlapping of T PSA level. When T PSA level ≤10 ng/ml,F/T ratio is of significant value to differentiate PCa from BPH patients, 0.16 (F/T) being a reasonable critical value,whereas F/T is of no significance when T PSA level is >10 ng/ml.