血清游离态前列腺特异抗原水平在前列腺疾病诊断中的应用价值

Diagnostic value of serum free PSA level in the diagnosis of prostate disease

目的 :探讨血清游离态前列腺特异抗原 (F PSA)和总PSA(T PSA)及F PSA/T PSA比值 (F/T比值 )在前列腺疾病诊断中的应用价值。方法 :采用ELISA方法测定 30例良性前列腺增生 (BPH)患者和 4 5例前列腺癌 (PCa)患者血清F PSA和T PSA水平 ,并计算F/T比值。结果 :BPH与PCa组患者T PSA、F PSA值经t检验差异有显著性意义 (P <0 .0 5 ) ,其F/T比值差异有极显著性意义 (P <0 .0 1) ,在PCa的诊断灰区 (T PSA值4 .0～ 10 .0 μg/L)中 ,F PSA及F/T比值能有效区分BPH与PCa(P <0 .0 5 ) ,单独以T PSA或F PSA作为PCa的诊断指标 ,其敏感度虽高 (88.89% ,84 .4 4 % ) ,但其特异性较低 (仅为 5 3.33% ,5 6 .6 7% ) ,而以F/T比值作为PCa的诊断指标 ,在保持较高敏感度的同时 ,其特异性也可显著提高 (P <0 .0 5 )。结论 :F PSA及F/T比值的引入 ,使PSA作为PCa的诊断指标更为有效 ,尤其在PCa的诊断灰区 。

Purpose:To research the clinical value of serum free PSA (F PSA), total PSA (T PSA) and F PSA/T PSA ratio for the differential diagnosis of BPH and PCa.Methods:The level of serum free prostate specific antigen and total prostate specific antigen were detected by ELISA in 30 cases of benign prostate hyperplasia (BPH) and in 45 cases of prostate cancer. And F PSA/T PSA ratio was calculated.Results:The level of serum T PSA,F PSA in PCa were significantly higher than those in BPH (P< 0.05 ), and the ratio (F/T)was significantly higher(P< 0.01 ), especially when the T PSA value between 4.0 ～ 10.0 μg/L (the diagnostic gray zone). When the F PSA or T PSA were used as the diagnostic criteria for PCa, the sensitivity were higher ( 88.89 %and 84.44 %), but the specificity were lower (only 53.33 % and 56.67 %).When using F PSA/T PSA ratio as diagnostic criteria for PCa, the sensitivity and the specificity were significantly higher (P< 0.05 ).Conclusions:With the introduction F PSA and F PSA/T PSA ratio, the PSA as diagnostic criteria for PCa may be more useful especially the PSA is within the diagnostic gray zone, and the F PSA/T PSA ratio can significantly enhance the specificity for PCa diagnosis.