炎症因子联合游离/总前列腺特异性抗原比值与前列腺健康指数密度检测在前列腺癌早期诊断中的临床应用

Clinical application of inflammatory factors combined with free/total prostate-specific antigen ratio and prostate health index density detection in early diagnosis of prostate cancer

目的探讨炎症因子[中性粒细胞与淋巴细胞绝对值比值(NLR)、C-反应蛋白(CRP)]联合游离/总前列腺特异性抗原比值(f/tPSA)与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。方法采用回顾性研究模型,选择2020年1月—2022年1月徐州矿务集团第一医院收治住院并诊断为早期前列腺癌的50例患者作为前列腺癌组,诊断为良性前列腺增生的50例患者作为良性前列腺增生组;另外选择同期前列腺大小正常的50名老年体检者作为对照组。检测所有入组人员中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、CRP、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)水平,计算NLR、f/tPSA、前列腺健康指数(PHI)和PHID;比较两组上述指标水平的差异。绘制受试者工作特征(ROC)曲线并计算ROC曲线下面积(AUC),比较各指标对前列腺癌的诊断效能。结果前列腺癌组患者的NLR、CRP、PHID水平均明显高于对照组[NLR:2.295(1.698,2.865)比1.950(0.903,2.333),CRP(mg/L):1.655(0.323,2.323)比0.275(0.120,0.585),PHID:2.895(0.968,3.300)比0.455(0.168,0.855),均P<0.05],CRP、PHID水平均明显高于良性前列腺增生组[CRP(mg/L):1.655(0.323,2.323)比0.975(0.283,1.358),PHID:2.895(0.968,3.300)比1.560(0.440,2.560),均P<0.05],f/tPSA水平明显低于良性前列腺增生组和对照组[f/tPSA:0.135(0.120,0.163)比0.195(0.168,0.213)、0.375(0.248,0.545),均P<0.05]。良性前列腺增生组患者的CRP、PHID水平均明显高于对照组,f/tPSA水平明显低于对照组,差异均有统计学意义(均P<0.05)。PHID诊断早期前列腺癌的AUC最大,为0.895[95%可信区间(95%CI)为0.831~0.959]。f/tPSA诊断早期前列腺癌的敏感度最高,为86.0%;PHID诊断早期前列腺癌的特异度最高,为100.0%。f/tPSA诊断良性前列腺增生的AUC最大,为0.816(95%CI为0.723~0.908);f/tPSA诊断良性前列腺增生的敏感度最高,为86.0%;PHID诊断良性前列腺增生的特异度最高,为98.00%。f/tPSA鉴别早期前列腺癌和良性前列腺增生的AUC最大,为0.738(95%CI为0.631~0.844);f/tPSA鉴别早期前列腺癌和良性前列腺增生的敏感度最高,为76.0%;CRP鉴别早期前列腺癌和良性前列腺增生的特异度最高,为96.0%。结论在前列腺相关疾病的诊疗中,血清NLR、CRP联合f/tPSA和PHID等水平变化均具有一定的临床意义,可为前列腺癌高风险人群的早诊断、早治疗及预后评价提供参考。

Objective To explore the clinical application of inflammatory factors[neutrophil to lymphocyte ratio(NLR),C-reactive protein(CRP)]combined with free/total prostate-specific antigen ratio(f/tPSA)and prostate health index density(PHID)in early diagnosis of prostate cancer.Methods Using a retrospective study model,50 patients diagnosed with early prostate cancer in the First Hospital of Xuzhou Mining Group from January 2020 to January 2022 were selected as prostatic cancer group,50 patients diagnosed with benign prostatic hyperplasia were included as benign prostatic hyperplasia group,and 50 elderly examiners with normal prostate size during the same period were as control group.All enrolled members were tested for neutrophil count(NEU),lymphocyte count(LYM),CRP,total prostate-specific antigen(tPSA),free prostate-specific antigen(fPSA),prostate-specific antigen homolog 2(p2PSA)and other indicators.NEU to LYM ratio(NLR),free/total prostate-specific antigen ratio(f/tPSA),prostate health index(PHI)and prostate health index density(PHID)were calculated.The differences in levels of above indicators between the two groups were compared,and receiver operator characteristic(ROC)curve was drawn and area under ROC curve(AUC)was calculated to compare the diagnostic efficacy of various indicators for prostate cancer.Results The levels of NLR,CRP and PHID in prostatic cancer group were higher than those in control group[NLR:2.295(1.698,2.865)vs.1.950(0.903,2.333),CRP(mg/L):1.655(0.323,2.323)vs.0.275(0.120,0.585),PHID:2.895(0.968,3.300)vs.0.455(0.168,0.855),all P<0.05],and the levels of CRP and PHID were higher than those in benign prostatic hyperplasia group[CRP(mg/L):1.655(0.323,2.323)vs.0.975(0.283,1.358),PHID:2.895(0.968,3.300)vs.1.560(0.440,2.560),both P<0.05],while the level of f/tPSA was lower than those in benign prostatic hyperplasia group and control group[f/tPSA:0.135(0.120,0.163)vs.0.195(0.168,0.213),0.375(0.248,0.545),both P<0.05].The levels of CRP and PHID in benign prostatic hyperplasia group were higher than those in control group,and the level of f/tPSA was lower than that in control group,with statistical significance(all P<0.05).The AUC of PHID for the diagnosis of early prostate cancer was higher than those of other indicators,which was 0.895[95%confidence interval(95%CI)was 0.831-0.959].The sensitivity of f/tPSA for the diagnosis of early prostate cancer was higher than those of other indicators,which was 86.0%.The specificity of PHID for the diagnosis of early prostate cancer was higher than those of other indicators,which was 100.0%.The AUC of f/tPSA for the diagnosis of benign prostatic hyperplasia was higher than those of other indicators,which was 0.816(95%CI was 0.723-0.908).The sensitivity of f/tPSA for the diagnosis of benign prostatic hyperplasia was higher than those of other indicators,which was 86.0%.The specificity of PHID for the diagnosis of benign prostatic hyperplasia was higher than those of other indicators,which was 98.00%.The AUC of f/tPSA for distinguishing early prostate cancer from benign prostatic hyperplasia was higher than those of other indicators,which was 0.738(95%CI was 0.631-0.844).The sensitivity of f/tPSA for distinguishing early prostate cancer from benign prostatic hyperplasia was higher than those of other indicators,which was 76.0%.The specificity of CRP for distinguishing early prostate cancer from benign prostatic hyperplasia was higher than those of other indicators,which was 96.0%.Conclusion In the diagnosis and treatment of prostate related diseases,changes in serum levels of NLR,CRP,f/tPSA and PHID have certain clinical significance,which could provide reference for early diagnosis,treatment,and prognosis evaluation of high-risk individuals with prostate cancer.