前列腺特异性抗原同源异构体2及其百分比和前列腺健康指数在鉴别良恶性前列腺疾病中的价值

The value of prostate-specific antigen homeomer 2,percentage and prostate health index in differentiating benign and malignant prostate diseases

目的通过实验研究前列腺特异性抗原同源异构体2(prostate-specific antigen isoform 2,p2PSA)、前列腺特异性抗原同源异构体2百分比(prostate-specific antigen isoform 2 percentage,p2PSA%)和前列腺健康指数(prostate health index,PHI)在鉴别良恶性前列腺疾病中的价值。方法以2021年3月至2023年5月河南省人民医院收治的80例经穿刺活检确诊的前列腺疾病患者为研究对象,根据病情诊断将所有前列腺疾病患者分为两组,一组为良性前列腺疾病组(良性组),共42例患者;另一组为恶性前列腺疾病,即前列腺癌组(恶性组),共38例患者。采集所有研究对象空腹时间8 h以上的静脉血液4 mL,测试血清中总前列腺特异性抗原(total prostate-specific antigen,t-PSA)、游离前列腺特异性抗原(free prostate-specific antigen,f-PSA)、p2PSA水平,并计算得到p2PSA、PHI水平,进行记录并做数据分析,评价各指标对鉴别良恶性前列腺疾病的价值。通过ROC曲线可以得知,t-PSA、f-PSA、p2PSA、p2PSA%、PHI断前列腺癌的特异性时,采用控制变量法,通过固定某几个标志物的值来判断其他标志物的比较优势或劣势。结果良性组患者血清中t-PSA、p2PSA、p2PSA%、PHI指标的水平比恶性组显著降低,差异具有统计学意义(P<0.05);两组之间f-PSA指标水平的差异无统计学意义。前列腺癌的AUC分别为0.64、0.58、0.75、0.83、0.86。另通过控制变量法得出p2PSA、PHI与其他指标相比,在特异性和敏感性上都有比较大的优势。由此可以看出,p2PSA%、PHI的AUC较大,在鉴别前列腺癌上更有效。结论在鉴别良恶性前列腺疾病的多种标志物中,p2PSA、p2PSA%以及PHI,尤其是PHI,比传统的PSA检测方法具有更好的效果,能够明显地提高敏感度与特异性、减少穿刺活检次数、减少误诊。p2PSA与PHI的联合检测,将为临床前列腺癌的诊断、治疗与预后提供重要参考。

Objective Experimental study on Prostate-specific antigen isoform 2(Prostate-specific antigen isoform 2,p2PSA),Prostate-specific antigen isoform 2 percentage(p2PSA%)and prostate health index(prostate Health Index,PHI)in the value in differentiating benign and malignant prostate diseases.Methods Taking 80 patients with prostate diseases diagnosed by needle biopsy admitted to Henan Provincial People's Hospital from March 2021 to May 2023 as the study object,all patients with prostate diseases were divided into two groups according to disease diagnosis.The first group was benign prostate disease group(benign group),with a total of 42 patients;the other group was malignant prostate disease,namely prostate cancer group(malignant group),with a total of 38 patients.4 mL of venous blood of all subjects was collected after fasting for more than 8 h,and total prostate-specific antigen(t-PSA),free prostate-specific antigen(f-PSA),and p2PSA levels in serum was tested,and the levels of p2PSA and PHI are calculated,recorded and analyzed for data to evaluate the value of each indicator in differentiating benign and malignant prostate diseases.When comparing the specificity of each serum marker for the diagnosis of prostate cancer,the control variable method was used to determine the comparative advantage or disadvantage of other markers by fixing the values of some markers.Results The levels of t-PSA,p2PSA,p2PSA%,and PHI indicators in the serum of patients in the benign prostate disease group were significantly lower than those of the prostate cancer group,and the difference between the two groups was significant(P<0.05);the levels of f-PSA indicators between the two groups were not statistically significant(P>0.05).It can be known from the ROC curve that the AUCs of t-PSA,f-PSA,p2PSA,p2PSA%,and PHI in determining prostate cancer are 0.64,0.58,0.75,0.83,and 0.86 respectively.In addition,through the control variable method,it was concluded that p2PSA and PHI have greater advantages in specificity and sensitivity compared with other indicators.It can be seen that the AUC of p2PSA%and PHI is larger and more effective in identifying prostate cancer.Conclusion Among the various markers for identifying benign and malignant prostate diseases,p2PSA,p2PSA%and PHI,especially PHI,have better results than the traditional PSA detection method,and can significantly improve the sensitivity and specificity,and reduce the number of puncture biopsies and misdiagnosis.The joint detection of p2PSA and PHI will provide an important reference for the diagnosis,treatment and prognosis of clinical prostate cancer.