尿液DD3mRNA定量检测在前列腺癌诊断中的价值

DD3 mRNA Analysis in Urine for the Diagnosis of Prostate Cancer

目的探讨前列腺按摩后尿沉渣中DD3mRNA含量在前列腺癌诊断中应用价值。方法收集前列腺癌(Pca)患者18例、良性前列腺增生(BPH)33例,在前列腺穿刺活检前收集前列腺按摩后的尿液,离心取细胞沉淀物,用荧光实时定量RT- PCR方法检测DD3 mRNA和PSAmRNA含量,以PSAmRNA作为管家基因校正尿沉渣中的前列腺细胞,以DD3mRNA/PSAmR- NA比值表示尿DD3mRNA含量。用ROC曲线对DD3mRNA诊断PCa的性能进行分析,并与血清tPSA进行了比较,同时探讨了尿DD3mRNA阳性率与临床分期和病理分级的关系。结果Pca患者尿DD3mRNA表达量明显高于BPH患者,差异具有统计学意义(P【0.05)。ROC曲线分析结果显示,ROC-AUC=0.716(95%CI:0.572～0.861)。当截断值为0.118时,DD3mRNA的灵敏性、特异性、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为67.0%、78.8%、77.4%、63. 2%、83.9%、3.41和0.35。若血清tPSA分别以4ng/ml和10ng/ml为截断值时,灵敏度分别为100%和94.4%,特异度分别为15.25和57.6%。DD3mRNA的阳性率与临床分期和病理分级无关。结论DD3mRNA的特异性明显高于血清PSA,尿液DD3mRNA的检测可减少不必要的前列腺穿刺,作为PCa的一种非损伤性诊断方法具有良好的应用前景。

Objective To study the clinical utility of DD3mRNA expression in urine after prostate massage.Methods DD3mRNA was detected by a real-time fluorescent quantitative reverse transcription polymerase chain reaction(FQ-RT-PCR)based on Taqman technique in Urine samples of 33 BPH and 18 PCa patient after prostate massage.PSA was used as a housekeeping gene to normalize the number of prostate cell,and then DD3mRNA/PSAmRNA ratio was used as a diagnostic tool for the accurate identification of pros- tate cancer cells and to compare the DD3mRNA expression in urinary sediment between BPH and Pca patients.The ROC curve was used to evaluate the diagnostic efficacy of DD3mRNA in urine samples and compared with serum tPSA.DD3mRNA expression among different clinic pathological parameters was analysed.Results There was significant difference of DD3mRNA expression in urinary sediment between BPH and Pca patients(P<0.05).The AUC-ROC was 0.716(95% CI:0.572～0.861)at cutoff 0.118.The sen- sitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio for DD3mRNA were 67.0%,78.8%,77.4%,63.2%,83.9%,94.3%,3.41 and 0.35,respectively.The sensitivity was 100% and 94.4% and the specificity was 15.2% and 57.6% at serum tPSA cutoff value 4ng/ml and 10ng/ml,respectively.There was no sig- nificant difference between DD3mRNA positive rate and clinic pathological parameters.Conclusion DD3mRNA expression had ex- cellent diagnose efficacy for proatate cancer as a non-invasive method and its specificity is superior to serum tPSA.