摘要
目的探讨不同血清前列腺特异抗原（PSA）水平前列腺癌检出情况以及直肠指诊（DRE）、经直肠超声检查（TRUS）、PSA密度（PSAD）等指标对筛查前列腺穿刺活检病例的意义。方法回顾性分析在1996年4月至2002年12月间行TRUS引导前列腺6点系统穿刺活检的634例患者的诊断资料，对各PSA组（≤4．0，4．1～，10．1～和〉20．0μg／L组）中前列腺癌的检出率，以及PSA、DRE、TRUS、PSAD等对前列腺癌的预测作用进行t检验、x^2检验和多因素Logistic回归分析。结果PSA≤4．0，4．1～，10．1～和〉20．0μg/L各组的前列腺癌检出率分别为11．6％（17／146），26．8％（38／142），39．8％（68／171）和68．6％（120／175）。PSA的敏感性最高（93．0％），特异性低（33．0％）；DRE、TRUS等诊断效率较低。随血清PSA水平升高，前列腺癌检出率以及DRE、TRUS的阳性预测值逐渐升高；在PSA4．1～20．0μg/L者中，PSAD对前列腺癌有较大的预测价值（OR=687．09±646．96，P=0．000）。以PSADI〉0．13μg·L^-1·cm^-3为截点筛查前列腺穿刺病例，可在不明显降低敏感性的基础上，减少阴性穿刺。结论各PSA组国人与欧美等国前列腺癌检出率有较大差别；DRE、TRUS的筛查作用与血清PSA水平有关；按PSA水平分组筛查穿刺病例，可提高前列腺穿刺的阳性率。
Objective To evaluate the detection of prostate cancer in different prostate specific antigen （PSA） level and the predict value of PSA, digital rectal examination （ DRE）, transrectal ultrasound scan （TRUS） and PSA density （PSAD）. Methods The clinical data of 634 cases who had underwent transrectal ultrasound guided systematic sextant prostate biopsies between April 1996 to December 2002 due to being suspicious of prostate cancer were retrospectively analyzed. The detection of prostate cancer in different PSA groups, namely PSA≤4. 0,4.1～, 10. 1～, 〉20. 0μg/L, and the predict values of PSA, DRE, TRUS and PSAD were statistically analyzed using t test, x^2 test and logistic regression analysis. Results The rates of prostate cancer detection in different PSA groups were 11.6% , 26. 8%, 39. 8% and 68.6%, respectively. The higher the PSA, the higher the rate of prostate cancer detection, the same was the positive predictive value of DRE and TRUS. The sensitivity and specificity of PSA 〉 4. 0μg/L were 93.0% and 33.0%, and the efficiency of DRE and TRUS were very low. Logistic regression analysis indicated that PSAD was the most risk factor of prostate cancer in the group of PSA 4. 1-20. 0μg/L （ OR = 687.09 ± 646. 96,P = 0. 000）. Conclusions The rates of prostate cancer detection in different PSA groups are different compared with other countries. The screening roles of DRE and TRUS are dependent on PSA level. Utilization of the screening protocol which to stratify cases into three PSA groups, namely PSA≤4. 0, 4. 1-20. 0, 〉 20. 0μg/L, can elevate the positive rate of prostate biopsies without sacrificing cancers detected.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2006年第6期372-375,共4页
Chinese Journal of Surgery
