p2PSA及其相关指标联合NLR和Cys C对前列腺癌的诊断价值分析

Diagnostic Value of p2PSA and Its Related Indexes Combined with NLR and Cys C in Prostate Cancer

目的研究前列腺特异性抗原前体2型(p2PSA)、前列腺特异性抗原前体2型百分比(%p2PSA)及前列腺健康指数(phi值)联合中性粒细胞与淋巴细胞比值(NLR)和胱抑素C(Cys C)在前列腺癌的诊断中的价值。方法选取2020年12月至2021年6月于我院经临床病理确诊的前列腺癌患者124例作为观察组,选取同期于我院就诊的良性前列腺增生患者118例为对照1组,选取同期我院健康体检患者120例作为对照2组,检测所有研究对象的总PSA(tPSA)、游离PSA(fPSA)、p2PSA、NLR、Cys C,计算游离与总前列腺特异性抗原比值(f/tPSA)、%p2PSA及phi值,比较各项指标在两组间的差异。运用受试者工作特征(ROC)曲线评价各个指标单一以及联合检测对前列腺癌的诊断价值。结果观察组tPSA、NLR、Cys C、p2PSA、%p2PSA及phi值结果明显高于对照组,f/tPSA明显低于对照组,差异有统计学意义(P<0.05)。三组间fPSA水平比较,无显著差异(P>0.05)。对照1组NLR、Cys C水平高于对照2组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,tPSA、f/tPSA、NLR、Cys C、p2PSA、%p2PSA及phi值诊断前列腺癌的曲线下面积(AUC)分别为0.799、0.780、0.807、0.774、0.888、0.842、0.899,p2PSA、%p2PSA及phi值对前列腺癌的诊断价值优于其他指标(P<0.05),p2PSA+NLR+Cys C联合检测诊断的AUC最大,特异性最高(P<0.05),与phi值+NLR+Cys C的AUC无显著差异(P>0.05),其敏感度最高(P<0.05)。结论相比于传统的前列腺癌肿瘤标志物,p2PSA及其相关指标具有更高的敏感性和特异性,联合NLR、Cys C对前列腺癌的诊断效能要优于单一指标检测,可降低前列腺癌的漏诊率。

Objectives To investigate the value of prostate specific antigen precursor type 2(p2PSA),percentage of prostate specific antigen precursor type 2(%p2PSA)and prostate health index(phi value)combined with neutrophil-lymphocyte ratio(NLR)and cystatin C(Cys C)in the diagnosis of prostate cancer.Methods A total of 124 patients with prostate cancer diagnosed by clinical pathology in our hospital from December 2020 to June 2021 were selected as the observation group,118 patients with benign prostatic hyperplasia treated in our hospital during the same period were selected as the control group 1,and 120 healthy patients who underwent physical examination in our hospital during the same period were selected as the control group 2.The total PSA(tPSA),free PSA(fPSA),p2PSA,NLR,Cys C of all subjects were detected,the ratio of free to total prostate-specific antigen(f/tPSA),%p2PSA and phi value were calculated,and the differences of each index between the two groups were compared.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of single and combined detection for prostate cancer.Results The tPSA,NLR,Cys C,p2PSA,%p2PSA and phi value of the observation group were significantly higher than those in control group,and f/tPSA was significantly lower than that of the control group(P<0.05).There was no significant difference in fPSA level among the three groups(P>0.05).The levels of NLR and Cys C in the control group 1 were significantly higher than those in control group 2(P<0.05).ROC curve analysis results showed that the area under the curve(AUC)of tPSA,f/tPSA,NLR,Cys C,p2PSA,%p2PSA and phi value in the diagnosis of prostate cancer were 0.799,0.780,0.807,0.774,0.888,0.842 and 0.899,respectively.The diagnostic value of p2PSA,%p2PSA and phi value was superior to other indicators(P<0.05).The combined detection of p2PSA+NLR+Cys C had the largest diagnostic AUC and the highest specificity(P<0.05),and there was no statistical significance between the AUC of P2PSA+NLR+Cys C and phi value+NLR+CYS C(P>0.05),which has the highest sensitivity(P<0.05).Conclusions Compared with traditional prostate cancer tumor markers,p2PSA and its related indicators have higher sensitivity and specificity.The diagnostic efficacy of combined NLR and Cys C for prostate cancer is better than that of single index detection,which can reduce the rate of missed diagnosis of prostate cancer.