磁性纳米微粒介导的尿前列腺癌抗原3检测诊断前列腺癌的价值

Diagnostic accuracy of urinary PCA3 test by magnetic nanoparticle mediated approach for prostate cancer

目的探讨磁性纳米微粒介导的尿前列腺癌抗原3（PCA3）检测诊断前列腺癌的价值。方法对2014年9月至2015年5月在我院行前列腺穿刺活检的90例患者行诊断试验研究。诊断试验为尿PCA3检测,分别采用磁性纳米微粒介导法和传统尿沉淀法。诊断的金标准为前列腺穿刺活检病理。绘制尿PCA3诊断前列腺癌的受试者工作特征曲线,计算曲线下面积（AUC）,比较两种不同检测方法诊断前列腺癌的价值,计算灵敏度和特异度等。结果 90例患者中活检诊断前列腺癌25例,磁性纳米微粒介导法的AUC为0.934（95%CI=0.881~0.986,P〈0.001）,高于传统尿沉淀法的0.792（95%CI=0.668~0.915,P〈0.001）。磁性纳米微粒介导法测得的尿PCA3分值,当临界点为25时,诊断前列腺癌的敏感度为77.3%,特异度为91.2%。结论磁性纳米微粒介导的尿PCA3检测,能提高检测的敏感性,诊断价值优于传统尿沉淀法。

Objective To investigate the diagnostic accuracy of urinary prostate cancer antigen 3（PCA3）test by magnetic nanoparticle mediated approach for prostate cancer.Methods Altogether 90 patients who received prostate biopsy in our department during Sept.2014 and May 2015 were enrolled in this prospective study.All patients had indications of prostate biopsy due to elevated prostate specific antigen or abnormal results of digital rectal examination.The index tests were urinary PCA3 tests,either by magnetic nanoparticle mediated approach or urinary sediment approach.The gold standard of diagnosis for prostate cancer was prostate biopsy.The receiver operating characteristic curves of PCA3 were drawn and area under curve（AUC）was calculated to compare the diagnostic accuracy of the two different approaches.Sensitivity,specificity,positive predictive value,negative predictive value and likelihood ratio were calculated.Results Among the 90 cases,25 were diagnosed as prostate cancer.The AUC obtained by the magnetic nanoparticle mediated approach was 0.934（95%CI,0.881~0.986,P0.001）,higher than that by the traditional sediment approach,which was 0.792（95%CI,0.668~0.915,P0.001）.For nanoparticle mediated approach,when the cutoff value of PCA3 score was 25,the sensitivity was 77.3%,and the specificity was 91.2% for the diagnosis of prostate cancer.Conclusion The diagnostic accuracy of urinary PCA3 test by magnetic nanoparticle mediated approach is superior to that by urinary sediment approach.