摘要
目的:探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、核磁共振成像(magnetic resonance imaging,MRI)、血清前列腺特异性抗原同源异构体2(serum prostate-specific antigen isoform 2,p2PSA)及其相关指标前列腺健康指数(prostate health index,PHI)在PSA介于4~20 ng/mL之间的前列腺癌(prostate cancer,PCa)诊断过程中的价值。方法:选取2021年1月—2022年1月嘉兴市第一医院前列腺穿刺患者342例,符合入组条件的205例,分为PCa组(96例)和良性前列腺增生(benign prostatic hyperplasia,BPH)组(109例)。在PCa患者的亚组分析中,根据病理Gleason评分,将PCa患者分为高危组(36例)和非高危组(60例)。检测患者血清总前列腺特异性抗原(total prostate specific antigen,tPSA)、p2PSA、游离前列腺特异性抗原(free prostate specific antigen,fPSA)水平,计算出PHI。检测血常规,根据中性粒细胞值及淋巴细胞值,计算出NLR值,比较各组指标的差异。结果:PCa组血清tPSA、MRI、p2PSA和PHI水平高于BPH组,差异有统计学意义(P<0.05);PCa组血清NLR水平低于BPH组,差异有统计学意义(P<0.05);受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,tPSA、NLR、MRI、p2PSA、PHI诊断PCa的曲线下面积(area under curve,AUC)分别为0.605、0.591、0.597、0.617、0.820;联合诊断方案中PHI+MRI、PHI+NLR、PHI+p2PSA、PHI+p2PSA+MRI、PHI+p2PSA+NLR、PHI+MRI+NLR方案的AUC均大于0.820,检测效能大于各指标单独检测,其中PHI+MRI+NLR方案最好(AUC=0.844)。在亚组分析中,高危PCa组tPSA、MRI、NLR和PHI水平高于非高危PCa组,差异有统计学意义(P<0.05)。结论:p2PSA和PHI对PSA介于4~20 ng/mL之间的诊断价值优于tPSA,可作为PCa更好的临床辅助诊断指标,PHI+MRI+NLR对PCa的联合诊断效能更高,可以弥补单项指标诊断的不足,提高PCa的检出率,降低漏诊率。tPSA、NLR、PHI能够预测PCa风险程度,NLR预测PCa的预后价值高于其诊断价值,但是NLR在PCa的诊断价值和预测PCa预后价值均低于tPSA。
Objective: To explore the value of neutrophil to lymphocyte ratio(NRL), magnetic resonance imaging(MRI), serum prostate-specific antigen isoform 2(p2PSA) and its related index prostate health index(PHI) in the diagnosis of prostate cancer(PCa) with PSA between 4 and 20 ng/mL. Methods: A total of 342 patients with prostate biopsy in Jiaxing First Hospital between Jan 2021 and Jan 2022 were selected, and 205 patients meeting the enrollment conditions were selected as PCa group(96 cases) and benign prostatic hyperplasia(BPH) group(109 cases), respectively. In subgroup analysis of PCa patients, PCa patients were divided into high risk group(36 cases) and non-high risk group(60 cases) according to pathological Gleason score. The serum levels of total prostate specific antigen(tPSA), p2PSA and free prostate specific antigen(fPSA) were detected to calculate the PHI. By blood routine examination, NLR was calculated according to neutrophil and lymphocyte values, and the differences among all groups were compared. Results: Serum levels of tPSA, MRI, p2PSA and PHI were higher in the PCa group than in the BPH group, and the difference was statistically significant(P<0.05), The serum NLR level in PCa group was lower than that in BPH group, and the difference was statistically significant(P<0.05). The results of the ROC curve analysis showed that the areas under the curve(AUC) for tPSA, NLR, MRI, p2PSA and PHI were 0.605, 0.591, 0.597, 0.617, and 0.820 respectively;The AUC of PHI+MRI, PHI+NLR, PHI+p2PSA, PHI+p2PSA+MRI, PHI+p2PSA+NLR, PHI+MRI+NLR in the combined diagnostic scheme were all greater than 0.820, and the detection efficiency was greater than that of each index alone. The PHI+MRI+NLR scheme was the best(AUC=0.844). In subgroup analysis, the levels of tPSA, MRI, NLR and PHI in high-risk PCa group were higher than those in non-high-risk PCa group, with statistical significance(P<0.05). Conclusion: The diagnostic value of p2PSA and PHI for PSA between 4 and 20 ng/mL is better than that of tPSA, so they can be used as better clinical auxiliary diagnosis indexes of PCa. The combination of PHI, MRI and NLR has higher diagnostic efficiency for PCa, which can make up for the deficiency of each individual indicator, improve the detection rate of PCa and reduce the rate of missed diagnosis. TPSA, NLR, p2PSA and PHI can predict the risk degree of PCa. The prognostic value of NLR in predicting PCa is higher than its diagnostic value, but the diagnostic value and prognostic value of NLR in predicting PCa are lower than those of tPSA.
作者
谢文华
何屹
顾燕琴
吴晓鸣
陈昊
XIE Wenhua;HE Yi;GU Yanqin;WU Xiaoming;CHEN Hao(Department of Urology,Jiaxing First Hospital,Jiaxing,Zhejiang,314000,China)
出处
《临床泌尿外科杂志》
CAS
2024年第3期198-202,205,共6页
Journal of Clinical Urology
基金
嘉兴市重点学科建设资助(No:2023-ZC-013)。
