前列腺健康指数对前列腺癌的诊断价值

The diagnostic value of prostate health index for prostate cancer

目的 探讨前列腺健康指数（PHI）对血清前列腺特异抗原（PSA）在4～ 10 μg/L、直肠指诊阴性（-）患者前列腺癌的诊断价值.方法 选择101例血清PSA在4～ 10 μg/L、直肠指诊（-）并接受经直肠B超引导下前列腺穿刺活检的老年男性的临床资料,其中前列腺癌16例、良性病变85例.检测血清总PSA（tPSA）、游离PSA（fPSA）和前列腺特异性抗原前体（p2 PSA）,分别计算游离PSA百分比（％ fPSA）、％p2PSA和PHI,以前列腺穿刺活检作为前列腺癌确诊依据,建立tPSA、％fPSA、p2PSA、％p2PSA和PHI的受试者工作特征曲线,计算曲线下面积（AUC）,分析tPSA、％fPSA、p2PSA、％p2PSA和PHI诊断前列腺癌的价值以及PHI预判前列腺癌侵袭性的价值.结果 前列腺癌组的tPSA、fPSA、p2PSA、％fPSA、％p2PSA和PHI均值分别为6.94、1.27 μg/L、21.49 ng/L、18.71％、1.59％、41.51,区别于非前列腺癌组的6.68、1.34 μg/L、13.37 ng/L、20.42％、1.05％、27.18;PHI、％p2PSA、p2PSA、％fPSA和tPSA的诊断前列腺癌的AUC分别为0.777、0.769、0.681、0.590、0.580.前列腺癌组中Gleason评分≥7组PHI均值明显大于Gleason评分≤6组PHI均值,差异有统计学意义（P＜0.05）.结论 PHI能进一步提高直肠指诊（-）、血清PSA在4～10 μg/L患者的前列腺癌诊断准确性,具有比％ p2PSA、p2PSA、％fPSA、tPSA更高的诊断价值,而且PHI值与前列腺癌侵袭性呈正相关.

Objective To investigate the role of prostate health index （PHI） in prostate cancer detection with a serum prostate specific antigen （PSA） level of 4-10 μg/L and negative digital rectum examination （DRE）.Methods In a prospective study from October 2013 to October 2014,the clinical data of 101 old men were analyzed.All the 101 cases were DRE （-）,had the serum PSA level of 4-10 μg/L and received prostate biopsy guided by transrectal ultrasound,including 16 cases of prostate cancer and 85 cases of benign prostate diseases.Serum total PSA （tPSA）,free PSA （fPSA） and proPSA （p2PSA） were detected and % fPSA,% p2PSA and PHI were calculated.Using prostate biopsy for the definite diagnosis of prostate cancer,receiver operating characteristic curves （ROC） of PHI,% p2PSA,p2PSA,% fPSA and tPSA were established and the areas under the curve （AUC） were calculated.The diagnostic value of PHI,% p2PSA,p2PSA,% fPSA and tPSA,and the value of PHI for predicting aggressive prostate cancer were analyzed.Results In the prostate cancer group,average tPSA,fPSA,p2PSA,% fPSA,% p2PSA and PHI were 6.94,1.27 μg/L,21.49 ng/L,18.71%,1.59% and 41.51 respectively,which were different from those in the non-cancer group （6.68,1.34 μg/L,13.37 ng/L,20.42%,1.05% and 27.18）.The AUCs of PHI,% p2PSA,% fPSA and tPSA for diagnosis of prostate cancer were 0.777,0.769,0.681,0.590 and 0.580 respectively.In the prostate cancer group with Gleason score ≥7,the PHI value was higher than that of the group with Gleason score ≤6 （P 〈0.05）.Conclusion PHI can improve the diagnosis accuracy of prostate cancer in patients with the serum PSA level of 4-10 μg/L and DRE （-）.PHI has the diagnostic value better than tPSA,% fPSA,p2PSA or %p2PSA.PHI value is positively associated with the aggressive prostate cancer.