早期前列腺癌抗原-2和人类腺体激肽释放酶2在前列腺癌诊断中的临床意义

The clinical significance of early prostate cancer antigen 2 and human glandular kallikrein 2 in diagnosis of prostate cancer

目的探讨血清早期前列腺癌抗原-2(EPCA-2)和人类腺体激肽释放酶2(hK2)浓度在前列腺癌早期诊断提供理论依据。方法选择健康对照组58例、前列腺增生症组43例、前列腺癌组34例,用电化学发光法检测血清前列腺特异性抗原(PSA)浓度,用酶联免疫技术分别检测血清EPCA-2和hK2浓度,观察3组患者EPSA、PCA-2和hK2水平的差异和相关性,并探讨对前列腺癌的敏感度、特异度、阳性预测值和阴性预测值。结果前列腺癌组PSA、EPCA-2、hK2水平明显高于健康对照组和前列腺增生组,差异有统计学意义(q值分别为10.24、8.18、7.87、9.15、7.23、6.41,P<0.01);前列腺增生症组PSA、EPCA-2水平明显高于健康对照组,差异有统计学意义(q值分别为3.61、3.04,P<0.05),但hK2水平2组间差异无统计学意义(q=2.75,P>0.05)。PSA水平与EPCA-2、hK2水平呈正相关(r值分别为0.869,0.792,P<0.01),EPCA-2、hK2水平呈正相关(r=0.780,P<0.01)。以PSA>5 ng/ml为前列腺癌的判定标准,其预测前列腺癌的特异性偏低达60.4%,敏感性高达91.18%,阳性预测值43.66%,阴性预测值95.31%。以EPCA-2>30 ng/ml为前列腺癌的判定标准,其预测前列腺癌的特异性达96.04%,敏感性达94.12%,阳性预测值88.89%,阴性预测值97.98%。以hK2>0.17 ng/ml为前列腺癌的判定标准,其预测前列腺癌的特异性达87.13%,敏感性达88.24%,阳性预测值69.77%,阴性预测值95.65%。PSA、EPCA-2、hK2曲线下面积分别为0.758、0.951、0.877,3项观察指标依次预测前列腺的诊断价值依次为EPCA-2>hK2>PSA。结论前列腺癌患者血清EPCA-2、hK2检测,可以进一步提高诊断的准确性,避免误诊及漏诊,为临床诊疗方案提供有力的参考依据。

Objective To investigate the clinical significance of early prostate cancer antigen 2 （ EPCA-2） and human glandular kallikrein-2 （hK2） in diagnosis of prostate cancer .Methods Fifty-eight healthy subjects （control group）, 43 patients with prostate hyperplasia （prostate hyperplasia group ） and 34 patients with prostate cancer （ prostate cancer group） were enrolled in the study.The serum levels of prostate specific antigen （PSA） were detected by electrochemiluminescence method,and the serum levels of EPSA and hK2 were detected by ELISA.Moreover the differences and correlation among EPSA,PCA-2, hK2 were observed, besides, the predictive sensitivity, specificity, positive predictive value and negative predictive value were investigated.Results The serum levels of PSA,EPCA-2,hK2 in prostate cancer group were significantly higher than those in control group and those in prostate hyperplasia group （ P 〈0.01）.The serum levels of PSA,EPCA-2 in prostate hyperplasia group were significantly higher than those in control group （ P 〈0.05）,however,there were no significant differences in the serum levels of hK2 between two groups （ P 〉0.05）.The levels of PSA were positively correlated to those of EPCA-2,hK2 （ r =0.869,0.792,respectively, P 〈0.01）.Moreover the levels of EPCA-2 were positively correlated to those of hK2 （ r =0.780, P 〈0.01）.Taking PSA 〉5ng/ml as diagnostic criteria of prostate cancer ,its specificity to predict prostate cancer was 60.4%,and predictive sensitivity was 91.18%, positive predictive value was 43.66% and negative predictive value was 95.31%.Taking EPCA-2 〉30ng/ml as diagnostic criteria, its specificity to predict prostate cancer was 96.04%,and predictive sensitivity was 94.12%, positive predictive value was 88.98% and negative predictive value was 97.90%.Taking hK2 〉0.17ng/ml as diagnostic criteria,its specificity to predict prostate cancer was 87.13%,and predictive sensitivity was 88.24%, positive predictive value was 69.77% and negative predictive value was 95.65%.The area under curve of PSA,EPCA-2,hK2 was 0.758, 0.951, 0.877, respectively,and the diagnostic value to predict prostate cancer was EPCA-2 〉hK2 〉PSA.Conclusion The detection of serum levels of EPCA -2,hK2 in patients with prostate cancer can further improve the accuracy of diagnosis ,avoid misdiagnosis and missed diagnosis ,which provides a powerful reference basis for clinical diagnosis and treatment.