tPSA、β-Ⅰ型胶原羧基端肽、骨钙素联合诊断对前列腺癌骨转移的预测价值

Predictive value of combined diagnosis of tPSA, β-CTX and osteocalcin for bone metastasis of prostate cancer

目的探讨血清总前列腺特异性抗原(tPSA)、β-Ⅰ型胶原羧基端肽(β-CTX)、骨钙素(OC)联合诊断对前列腺癌(PCa)骨转移的预测价值,明确一种或多种骨标志物与PCa骨转移的相关性。方法回顾性选择2016年1月至2020年4月中国人民解放军陆军第八十一集团军医院及张家口市第一医院收治的93例PCa患者作为研究对象,根据核素骨显像分为PCa无骨转移组(43例)和PCa骨转移组(50例);根据骨转移数量分为局限性骨转移组(24例,骨转移病灶≤5个)和进展性骨转移组(26例,骨转移病灶>5个)。分别检测并记录tPSA及骨标志物,并对两组的各指标水平进行比较。结果与PCa无骨转移组比较,PCa骨转移组患者的血清tPSA、β-CTX、OC水平增加(均P<0.001)。与局限性骨转移组比较,进展性骨转移组患者的血清tPSA、β-CTX、OC表达水平均明显升高(均P<0.05)。PCa患者的血清tPSA、β-CTX、OC与骨转移数目呈正相关(P<0.05),且与发生骨转移相关(P<0.05),但与肿瘤分期无相关性(P>0.05)。tPSA、β-CTX以及OC单独诊断PCa骨转移的特异度较高,但灵敏度较差;采用联合诊断的灵敏度、阳性预测值、阴性预测值均高于tPSA、β-CTX以及OC单独诊断(均P<0.05)。联合检测的受试者工作特征(ROC)曲线下面积高于单独检测(P<0.05)。结论血清tPSA、β-CTX、OC联合检测对于前列腺骨转移的诊断价值较高,作为骨标志物与骨转移密切相关。

Objective To investigate the predictive value of serum total prostatic specific antigen(tPSA),β-I collagen carboxy-terminal peptide(β-CTX)and osteocalcin(OC)in the combined diagnosis of prostate cancer(PCa)bone metastasis,and to clarify the correlation of one or more bone markers to PCa bone metastasis.Methods A total of 93 patients with PCa who were admitted to PLA army 81st group army hospital and the first hospital of Zhangjiakou city from January 2016 to April 2020 were retrospectively selected as the study subjects.According to radionuclide bone imaging,they were divided into PCa non-metastatic group(43 cases)and PCa metastatic group(50 cases).According to the number of bone metastases,the patients were divided into local bone metastases group(24 cases,bone metastases≤5 lesions)and progressive bone metastases group(26 cases,bone metastases>5 lesions).tPSA and bone markers were detected and recorded,and the levels of each indicator were compared between the two groups.Results The levels of tPSA,β-CTX and OC in patients with PCa metastatic group were significantly increased compared with PCa non-metastatic group(all P<0.001).Compared with the local bone metastasis group,the expression levels of tPSA,β-CTX and OC in patients with progressive bone metastasis were significantly increased(all P<0.05).Serum tPSA,β-CTX and OC were positively correlated with the number of bone metastases in PCa patients(P<0.05),and were closely correlated with the occurrence of bone metastases(P<0.05),but there was no correlation between tumor stage(P>0.05).The specificity of tPSA,β-CTX and OC in the diagnosis of PCa bone metastasis was high,but the sensitivity was poor.The sensitivity,positive predictive value and negative predictive value of combined diagnosis were higher than those of tPSA,β-CTX and OC alone.ROC curve analysis showed that the area under ROC curve of combined detection was higher than that of single detection(P<0.05).Conclusions The combined detection of serum tPSA,β-CTX and OC is of high value in the diagnosis of prostate bone metastasis,and is closely related to bone metastasis as a bone marker.