血红蛋白与红细胞分布宽度比值在前列腺癌诊断中的预测价值

Predictive value of hemoglobin-to-red blood cell distribution width ratio in the diagnosis of prostate cancer

目的:探讨血红蛋白与红细胞分布宽度比值(hemoglobin-to-red-blood-cell-distribution-width ratio,HRR)在前列腺癌诊断中的价值。方法:回顾性分析2021年1月—2024年1月在中国人民解放军联勤保障部队第九四〇医院泌尿外科行前列腺穿刺活检的192例患者临床资料。根据术后病理分型分为前列腺癌组(82例)和良性前列腺增生组(110例)。收集2组患者一般资料,包括血常规、前列腺特异性抗原(prostate-specific antigen,PSA)等血液学检查以及超声、磁共振等影像学检查结果。对比2组患者临床指标的差异并进行单因素和多因素分析,建立前列腺癌诊断模型并评价其效能。结果:2组患者年龄、总前列腺特异性抗原(total prostate-specific antigen,tPSA)、前列腺体积、(胆碱+肌酸)/枸橼酸盐、HRR比较,差异有统计学意义(P<0.05)。多因素logistic分析结果显示高龄、tPSA升高、前列腺体积减小、HRR降低为患者发生前列腺癌的独立危险因素。建立预测模型,指标包括年龄、tPSA、前列腺体积、HRR。新模型受试者工作特征曲线下面积为0.868,灵敏度为81.08%,特异度为79.00%。在本研究中,HRR相较于其他炎性指标对前列腺癌预测效能最佳。结论:年龄、tPSA、前列腺体积、HRR可能是前列腺穿刺活检前预测前列腺癌有效的生物标记物,临床易于实施,值得进一步纳入多中心患者来评价其对前列腺癌患者的诊断作用。

Objective To explore the value of hemoglobin-to-red-blood-cell-distribution-width ratio(HRR)in the diagnosis of prostate cancer(PCa).Methods We retrospectively analyzed the clinical data of 192 patients undergoing prostate biopsy in the Department of Urology,the 940th Hospital of Joint Logistic Support Force of People's Liberation Army between Jan.2021 and Jan.2024.They were divided into two groups based on the pathological findings after prostate biopsy.One group was selected as PCa group(82 cases)and the other was benign prostatic hyperplasia(BPH)group(110 cases).Clinical information such as blood routine,prostate-specific antigen(PSA)and imaging findings were collected.We compared the differences of the risk factors between these two groups,and analyzed them by simple correlation and multiple stepwise regressions.A united model that can predict PCa was constructed based on multivariate analysis and this model's capability was evaluated by using receiver operating characteristic curve.Results In this study,HRR had a better ability to predict PCa,compared with other inflammation parameters.The difference of age,total PSA(tPSA),prostate volume,(choline+creatine)/citrate and HRR between two groups was significant(P<0.05).Multivariate analysis showed that age,tPSA,prostate volume and HRR were independent risk factors in PCa.We set up a united model including four former clinical factors.The sensitivity and the specificity of this united model were 81.08%and 79.00%,respectively.The area under the receiver operating characteristic curve value was 0.868.Conclusion Age,tPSA,prostate volume and HRR were effective biomarkers for predicting PCa prior to prostate needle biopsy.These factors are easy to administer and worth popularizing,but further prospective clinical studies that include more patients from multiple centers are needed to evaluate their diagnostic role in PCa.