外周血中性粒细胞与淋巴细胞对不同PSA水平前列腺癌患者的诊断价值研究

Values of Neutrophil and Lymphocyte in Peripheral Blood in Diagnosis of Prostate Cancer Patients with Different PSA Levels

目的评估外周血中性粒细胞(NE)与淋巴细胞(LY)对不同前列腺特异性抗原(PSA)水平前列腺癌(PCa)患者的诊断价值。方法回顾分析2013年6月—2020年12月收治的PCa 238例(PCa组)和前列腺增生(BPH)319例(BPH组)临床资料,比较PSA<4.0 ng/ml、4.1~10.0 ng/ml范围内2组NE、LY、中性粒细胞与淋巴细胞比值(NLR)差异,并利用多因素Logistic回归分析探讨不同PSA水平下PCa的独立性预测指标。结果在PSA<4.0 ng/ml范围内,2组游离PSA(fPSA)、前列腺体积(PV)、LY、NE间存在差异(P<0.05,P<0.01);在PSA 4.1~10.0 ng/ml范围内,2组fPSA、PV、游离/总PSA(f/tPSA)、PSA密度(PSAD)间存在差异(P<0.01)。在PSA<4.0 ng/ml范围内,fPSA、PV、LY及NE为PCa独立性预测指标(P<0.05,P<0.01);而在PSA 4.1~10.0 ng/ml范围内,LY及NE均无预测PCa的能力(P>0.05)。在PSA<4.0 ng/ml范围内,利用fPSA、PV、LY及NE构建的PCa风险预测模型具有较高的诊断准确性,曲线下面积为0.827,明显高于PSAD的0.394、f/tPSA的0.578和NLR的0.588,差异有统计学意义(P<0.05)。结论在PSA<4.0 ng/ml范围内,NE与LY可用于诊断PCa,并且利用二者构建PCa风险预测模型可提高PCa诊断能力,而NLR在不同PSA水平均无法用于诊断PCa。

Objective To evaluate values of peripheral blood neutrophils(NE)and lymphocytes(LY)in diagnosis of prostate cancer(PCa)patients with different levels of prostate specific antigen(PSA).Methods Clinical data of 238 patients with PCa(PCa group)and 319 patients with benign prostate hyperplasia(BPH group)between June 2013 and December 2020 was retrospectively analyzed.The differences of NE,LY and neutrophil to lymphocyte ratio(NLR)within PSA less than 4.0 ng/ml and 4.1-10.0 ng/ml ranges were compared between two groups,and the independent predictors of PCa in patients with different levels of PSA were analyzed and discussed by multivariate Logistic regression analysis.Results In two groups,there were statistically significant differences in free-PSA(fPSA),prostate volume(PV),LY and NE in the range of PSA less than 4.0 ng/ml(P<0.05,P<0.01);there were statistically significant differences in fPSA,PV,free/total PSA(f/tPSA)and PSA density(PSAD)in the range of PSA 4.1-10.0 ng/ml(P<0.01).In the range of PSA less than 4.0 ng/ml,fPSA,PV,LY and NE were the independent predictors of PCa(P<0.05,P<0.01);in the range of PSA 4.1-10.0 ng/ml,LY and NE had no ability to predict PCa(P>0.05).In the range of PSA less than 4.0 ng/ml,the PCa risk prediction model was constructed by using fPSA,PV,LY and NE had good diagnostic accuracy,and its area under the curve was 0.827,which was significantly higher than 0.394 for PSAD,0.578 for f/tPSA and 0.588 for NLR(P<0.05).Conclusion In the range of PSA less than 4.0 ng/ml,NE and LY can be used to diagnose PCa,and PCA risk prediction model,which is constructed by using NE and LY,may improve diagnostic ability of PCa.However,NLR can not be used to diagnose PCA at different PSA levels.