游离和总前列腺特异性抗原比值、外周血中性粒细胞和淋巴细胞比值、白细胞介素6、前列腺健康指数密度检测在前列腺癌早期诊断中的应用

Application of free/total prostate-specific antigen ratio,peripheral blood neutrophil-to-lymphocyte ratio,interleukin-6 and prostate health index density detection in early diagnosis of prostate cancer

目的:探讨游离和总前列腺特异性抗原比值(f/tPSA)、外周血中性粒细胞和淋巴细胞比值(NLR)、白细胞介素6(IL-6)、前列腺健康指数密度(PHID)检测在前列腺癌早期诊断中的临床应用。方法:回顾性分析2020年1月至2022年1月徐州医科大学第二附属医院收治住院的160例前列腺特异性抗原(PSA)异常患者临床资料,根据前列腺穿刺活组织检查或电切手术病理结果分为前列腺癌组68例、良性前列腺增生组92例;选取同期徐州医科大学第二附属医院男性健康体检者50名为健康对照组。3组均检测总前列腺特异性抗原(tPSA)、游离前列腺特异性抗原(fPSA)、前列腺特异性抗原同源异构体2(p2PSA)、IL-6等指标,计算f/tPSA、前列腺健康指数(PHI)、PHID和NLR等。绘制受试者工作特征曲线(ROC),比较各指标诊断和鉴别诊断前列腺癌、良性前列腺增生的效能。结果:前列腺癌组患者血清tPSA、fPSA、p2PSA、PHI、PHID水平均高于良性前列腺增生组和健康对照组(均 P<0.05);血清f/tPSA水平均低于良性前列腺增生组和健康对照组(均 P<0.05)。PHID诊断早期前列腺癌的曲线下面积(AUC)最大[0.915(95% CI 0.864~0.966)],其次为PHI[0.884(95% CI 0.823~0.944)];f/tPSA和PHI诊断早期前列腺癌的灵敏度均为86.80%,高于其他指标;PHID诊断早期前列腺癌的特异度为94.00%,高于其他指标。f/tPSA诊断良性前列腺增生的AUC最大[0.828(95% CI 0.739~0.917)],其次为PHID[0.826(95% CI 0.760~0.892)];f/tPSA诊断良性前列腺增生的灵敏度高于其他指标,为85.90%;PHI诊断良性前列腺增生的特异度高于其他指标,为94.00%。fPSA、PHID、f/tPSA、p2PSA鉴别早期前列腺癌和良性前列腺增生的AUC分别为0.752(95% CI 0.663~0.841)、0.730(95% CI 0.647~0.812)、0.713(95% CI 0.623~0.803)、0.710(95% CI 0.629~0.791),各指标两两比较差异均无统计学意义(均 P>0.05)。NLR鉴别早期前列腺癌和良性前列腺增生的灵敏度均高于其他指标,为91.20%;fPSA鉴别早期前列腺癌和良性前列腺增生的特异度均高于其他指标,为94.00%。 结论:f/tPSA、PHI和PHID检测在前列腺癌早期诊断中具有一定临床价值,可为前列腺癌高风险人群早诊断、早治疗及预后评价提供参考。

ObjectiveTo investigate the clinical application of free/total prostate-specific antigen(f/tPSA),peripheral blood neutrophil-to-lymphocyte ratio(NLR),interleukin-6(IL-6)and prostate health index density(PHID)detection in the early diagnosis of prostate cancer.MethodsThe clinical data of 160 patients with abnormal prostate specific antigen(PSA)who were admitted to the Second Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2022 were retrospectively analyzed.According to the pathological results of prostate biopsy or electrical resection,the patients were divided into prostate cancer group(68 cases)and benign prostatic hyperplasia group(92 cases),and 50 male healthy physical examiners in the Second Affiliated Hospital of Xuzhou Medical University during the same period were selected as healthy control group.All enrolled members were tested for total prostate-specific antigen(tPSA),free prostate-specific antigen(fPSA),and prostate specific antigen isoform 2(p2PSA),IL-6 and other indicators,and the f/tPSA,prostate health index(PHI),PHID and NLR were calculated.Receiver operating characteristic(ROC)curve was plotted to compare the efficacy of each index in diagnosing and differentially diagnosing prostate cancer and benign prostatic hyperplasia.ResultsThe serum levels of tPSA,fPSA,p2PSA,PHI and PHID in the prostate cancer group were higher than those in the benign prostatic hyperplasia group and the healthy control group(all P<0.05),and the serum f/tPSA was lower than that in the benign prostatic hyperplasia group and the healthy control group(P<0.05).The area under the curve(AUC)of PHID for the diagnosis of early stage prostate cancer was the largest[0.915(95%CI 0.864-0.966)],followed by PHI[0.884(95%CI 0.823-0.944)].The sensitivity of both f/tPSA and PHI in diagnosing early stage prostate cancer was 86.80%,which was higher than other indicators;the specificity of PHID in diagnosing early stage prostate cancer was 94.00%,which was higher than other indicators.The AUC of f/tPSA for the diagnosis of benign prostatic hyperplasia was the largest[0.828(95%CI 0.739-0.917)],followed by PHID[0.826(95%CI 0.760-0.892)].The sensitivity of f/tPSA in diagnosing benign prostatic hyperplasia(85.90%)was higher than other indicators,and the specificity of PHI in diagnosing benign prostatic hyperplasia(94.00%)was higher than other indicators.The AUC of fPSA,PHID,f/tPSA and p2PSA in differentiating early stage prostate cancer and benign prostatic hyperplasia were 0.752(95%CI 0.663-0.841),0.730(95%CI 0.647-0.812),0.713(95%CI 0.623-0.803),0.710(95%CI 0.629-0.791),respectively,and there was no significant difference in each pairwise comparison(all P>0.05).The sensitivity of NLR in differentiating early stage prostate cancer and benign prostatic hyperplasia was 91.20%,which was higher than other indicators,and the specificity of fPSA in differentiating early stage prostate cancer and benign prostatic hyperplasia was 94.00%,which was higher than other indicators.ConclusionsThe f/tPSA,PHI and PHID detection have certain clinical values in the early diagnosis of prostate cancer,and can provide references for early diagnosis,early treatment and prognosis evaluation of high-risk population of prostate cancer.