维吾尔族与汉族前列腺穿刺患者前列腺特异性抗原水平、前列腺癌检出率与病理分级的比较

Analysis of differences of PSA levels, prostate cancer detection rate and pathological grading between Uygur and Han people

目的 探讨新疆地区维吾尔族与汉族前列腺癌发病差异以及可能的影响因素.方法 回顾性分析2007年5月至2013年10月以下尿路症状就诊且年龄＞50岁的维吾尔族和汉族患者,患者行PSA检测、直肠指检及经腹前列腺超声、MRI检查.符合前列腺穿刺活检指征者696例,其中维吾尔族152例、汉族544例,对两组患者不同年龄tPSA、不同tPSA水平前列腺癌检出率以及病理分级进行对比分析.tPSA值以中位数（四分位间距）表示. 结果 ①696例维吾尔族、汉族前列腺穿刺患者的tPSA值为15.5 （25.9）、18.7（36.7） μg/L,按照年龄分层,50 ～ 59岁组分别为11.1（1 1.6）、11.8（17.9） μg/L,60～ 69岁组15.6（39.0）、16.5 （33.0）μg/L,70 ～ 79岁组17.4（25.1）、18.3（40.2）μg/L,≥80岁组11.7（19.4）、44.4（71.5） μg/L.前列腺穿刺患者维吾尔族各年龄组tPSA水平均低于汉族,但仅≥80岁组差异有统计学意义,其余3组差异均无统计学意义（P＞0.05）.②共检出276例前列腺癌患者.维吾尔族、汉族前列腺癌检出率分别为34.2％ （52/152）、41.2％ （224/544）,按照PSA分层,＜4 μg/L组分别为0（0）、29.2％（7/24）,4～ 10 μg/L组16.1％ （5/31）、17.0％（18/106）,＞10～ 20 μg/L组14.3％ （7/49）、19.9％ （31/156）,＞20μg/L组64.5％（40/62）、65.1％（168/258）.维吾尔族各tPSA水平组前列腺癌检出率均低于汉族,但差异多无统计学意义（P＞0.05）.③维吾尔族、汉族前列腺癌病理分级高分化者12例（23.1％）、48例（21.4％）,中分化者17例（32.7％）、72例（32.1％）,低分化者23例（44.2％）、104例（46.4％）,组间比较差异无统计学意义（Z=-0.316,P=0.752）.④线性相关性分析显示,前列腺癌检出率与维吾尔族、汉族的年龄存在相关性（r=10.130、P=0.017,r=37.666、P=0.000）,与维吾尔族、汉族的PSA亦存在相关性（r=32.577、P=0.000,r=81.291、P=0.000）. 结论 新疆地区维吾尔族前列腺穿刺患者在不同年龄的tPSA值、不同tPSA水平的前列腺癌检出率均低于同水平的汉族人群,但差异无统计学意义.维吾尔族和汉族的前列腺癌病理分级构成比相似.前列腺癌检出率与汉族、维吾尔族的年龄与PSA水平均存在相关性.

Objective To investigate the differences in prostate cancer between Uygur and Han ethnic groups in Xinjiang and the possible factors influencing the differences.Methods A retrospective analysis was done in Uygur and Han patients over 50 years with lower urinary tract symptoms （LUTS） from May 2007 to October 2013.Six hundred and ninety-six patients （Uygur：152,Han：544） complying with prostate biopsy were picked out after PSA test,digital rectal examination,prostate ultrasound transabdominal and MRI.They were divided into 4 age groups based on every l0 years：50-59 years group,60-69 years group,70-79 years group,and ≥ 80 years group.A comparison was made in different tPSA levels of prostate cancer detection rates and pathological grading of Uygur and Han groups.Results The tPSA levels of Uygurs were as follows：50-59 years group：11.1 （11.6） μg/L; 60-69 years group：15.6 （39.0） μg/L; 70-79 years group：17.4 （25.1） μg/L; ≥ 80 years group：11.7 （19.4） μg/L.While the tPSA levels of Hans were as follows：50-59 years group：11.8 （17.9） μg/L; 60-69 years group：16.5 （33.0） μg/L; 70-79 years group：18.3 （40.2） μg/L; ≥80 years group：44.4 （71.5） μg/L.The tPSA level of Uygur cases in any age group was lower than that of Hans.Among 276 patients diagnosed with prostate cancer,the detection rates of Uygurs were as follows：〈4 μg/L group：0 （0） ; 4-10 μg/L group：16.1% （5/31） ; 〉10-20 μg/L group：14.3% （7/49）; 〉20 μg/L group：64.5% （40/62） and the detection rates of Hans were as follows：〈4 μg/L group：29.2% （7/24）; 4-10 μg/L group：17.0%（18/106）; 〉10-20 μg/L group：19.9% （31/ 156） ; 〉20 μg/L group：65.1% （168/258）.The detection rate of Uygurs in each group was lower than that of Hans but there were no significant differences （P〉0.05）.Pathological grading of prostate cancer between Uygur and Han cases were listed as follows：the well differentiated group：Uygur：12 （23.1%）,Han：48 （21.4%） ; the moderately differentiated group：Uygur：17 （32.7%）,Han：72 （32.1%） ; the poorly differentiated group：Uygur：23 （44.2%）,Han：104 （46.4%）.The levels between Uygurs and Hans were nearly the same （Z=-0.316）,showing no significant difference （P =0.752）.The prostate cancer detection rate was correlated with the ages of Uygurs and Hans （r=10.130,P=0.017; r=37.666,P=0.000）,and the prostate cancer detection rate was also correlated with the PSA levels of Uygurs and Hans （r=32.577,P =0.000; r=81.291,P=0.000）.Conclusions The tPSA level of Uygur cases in any age group and the detection rate of prostate cancer of Uygurs in each PSA group are lower than those of Hans but there are almost no significant differences.The prostate cancer detection rate is correlated with the ages and PSA levels of Uygurs and Hans.