血清FPSA/TPSA及性腺激素测定结合核素骨显像在前列腺癌诊断、复发和转移中的临床价值
Evaluation of serum FPSA/TPSA and hormone determination combinded with nuclide bone imaging in diagnosis of prostate carcinoma and its recidivation and metastasis
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摘要: 目的 探讨血清游离前列腺特异抗原(FPSA)、总前列腺特异抗原(TPSA)、FPSA/TPSA比值、血清催乳素、促卵泡激素(FSH)、促黄体激素(LH)、雌二醇、孕酮、睾酮的测定并结合99Tcm-MDP全身骨显像在前列腺癌诊断、前列腺良恶性疾病鉴别诊断及前列腺癌转移和复发中的临床价值。方法 采用罗氏电化学发光分析法测定44名健康男性、75例良性前列腺疾病[其中41例良性前列腺增生(BPH)、25例BPH伴急性尿潴留(BPH+AUR)者,9例急性前列腺炎(AP)]和48例经病理证实的前列腺癌患者血清催乳素、FSH、LH、雌二醇、孕酮、睾酮及TPSA、FPSA、FPSA/TPSA测定。用99Tcm-MDP对48例前列腺癌患者进行全身骨显像,分析各项指标对前列腺疾病诊断、鉴别诊断的临床价值。结果 ①前列腺癌及良性前列腺疾病患者TPSA、FPSA明显高于正常对照组(t1=11.42,t2=12.01,P<0.01);②前列腺癌患者TPSA、FPSA明显高于良性前列腺疾病组(t1=10.69,t2=11.18,P<0.01);③前列腺癌患者FPSA/TPSA比值明显低于BPH组(t=2.95,P<0.01),但与BPH+AUR组及AP组之间无明显差异(t1=0.73,t2=0.62,P>0.05)。④前列腺癌患者FSH、LH明显高于良性前列腺疾病组及正常对照组,睾酮低于正常对照组和BPH组,而其他性腺激素催乳素、雌二醇、孕酮无显著差异(P>0.05);⑤前列腺癌不同治疗方案的选择在治疗前后除根治术外,其他各组治疗前后FSH、LH、睾酮均有明显变化(FSH:t=4.01,P<0.01;LH:t=2.46,P<0.05;睾酮:t=3.20,P<0.01);⑥有骨转移的前列腺癌患者TPSA、FPSA显著高于未发生骨转移者(tTPSA=5.38,tFPSA=4.26,P<0.01),但FPSA/TPSA比值两者之间无显著差异(t=1.61,P>0.05)。结论 TPSA、FPSA在诊断前列腺癌、鉴别前列腺癌与良性前列腺疾病及判断骨转移等方面有着重要的临床价值;FPSA/TPSA<0.16时前列腺癌发生的风险将增大,但不能独立用于诊断前列腺癌,TPSA、FPSA和性腺激素测定结合99Tcm-MDP全身骨显像对于前列腺癌的诊断、疗效观察和判断复发与转移有着重要的临床价值。Abstract: Objective To evaluate the clinical value of free prostate antigen (FPSA), total prostate specific antigen (TPSA), FPSA/TPSA and serum hormones (PRL, FSH, LH, Prog, T, E2) combined with ECT bone imaging in patients with prostate carcinoma.Methods 44 healthy males, 75 patients of benign prostate disease (including 41 of benign prostatic hyperplasia (BPH) and 25 of HBP with acute urinary retention (BPH+AUR) surgery, 9 of acute prostatitis), and 48 patients with prostate carcinoma were enrolled in this study. Their Gonadal hormones and TPSA, FPSA, FPSA/TPSA were measured.Results ①The level of TPSA and FPSA in patients with prostate carcinoma or benign prostate disease were significantly higher than in healthy control (t1=11.42, t2=12.01, P<0.01); ②Those in patients with prostate carcinoma were obviously higher than in patients with benign prostate disease (t1=10.69, t2=11.18, P<0.01); ③The ratio of FPSA/TPSA in patients with prostate carcinoma was obviously lower than those with BPH 0,=10.69, t2=11.18, P<0.01), but there were no significant differences between patients with BPH+AUR and acute prostatitis (t1=0.73, t2=0.62, P>0.05); ④The FSH and LH of gonadal hormones in patients with prostate carcinoma were obviously higher than in patients with benign prostate diseases and healthy control.⑤Except patients having operation total correction, the gonadal hormones and FSH/LH, T in patients with prostate carcinoma having different treatment programs all had variances before and after therapy; ⑥TPSA and FPSA in patients with prostate carcinoma having bone metastasis were much higher than those without bone metastasis (tPSA=5.38, tfpsA=4.26, P<0.01), the ratio of FPSA/TPSA between those two had no significant disparity (t=1.61, P>0.05).Conclusion here was great clinlical value of the determination of TPSA and FPSA in diagnosis of prostate carcinoma, identification of prostate carcinoma and benign prostate disease and in judgment of bone metastasis. The ratio of FPSA/TPSA <0.16 is a proper prediction index for diagnosis of prostate carcinoma, FPSA/TPSA might be <0.16 in healthy ones and patients with acute prostatitis or BPH; but when FPSA/TPSA <0.16, the risk of prostate cancer would increase; Gonadal hormones is useful biomarkers in diagnosis and treatment in patients with prostate carcinoma.
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