游离前列腺特异性抗原联合癌胚抗原 对前列腺癌的早期诊断价值

Free prostate specific antigen combined with carcinoembryonic antigen for early diagnosis of prostate cancer

摘要:

目的 分析游离前列腺特异性抗原（fPSA）联合癌胚抗原（CEA）对前列腺癌的早期诊断价值。 方法 选取2017 年1 月—2019 年12 月在滁州市第一人民医院就诊的256 例疑似前列腺癌患者作为研究对象。 血清总前列腺特异抗原（tPSA）水平介于4.0 ～ 20.0μg/L，根据血清tPSA 水平分为tPSA 4.0 ～ 10.0μg/L 组180 例和tPSA 10.1 ～ 20.0μg/L 组76 例。比较两组前列腺癌与非前列腺癌患者血清fPSA、CEA、游离与 总前列腺特异性抗原比值（f/tPSA）、前列腺健康指数（PHI）。进行Pearson 相关性分析和线性回归性分析， 使用受试者工作特征曲线下面积（AUC）评价fPSA 联合CEA 对前列腺癌的诊断效能。结果 tPSA 4.0 ～ 10.0μg/L 组前列腺癌与非前列腺癌患者血清fPSA、CEA 水平比较，差异有统计学意义（P <0.05）；而年龄、 血清tPSA 水平、f/t PSA 及PHI 比较，差异无统计学意义（P >0.05）。tPSA 10.1 ～ 20.0μg/L 组前列腺癌与 非前列腺癌患者血清fPSA、CEA 及PHI 比较，差异有统计学意义（P <0.05）；而年龄、血清tPSA 水平及 f/t PSA 比较，差异无统计学意义（P >0.05）。Pearson 相关性分析显示，前列腺癌患者血清fPSA、CEA 水平与 PHI 呈正相关（r =0.348 和0.392，P <0.05）。线性回归分析显示，血清fPSA、CEA 水平是PHI 水平的影响因 素（b =0.046 和0.449，P <0.05）。ROC 曲线结果显示，FPSA 联合CEA 诊断前列腺癌的AUC 为0.921，大于 fPSA 的0.672 和CEA 的0.703（P <0.05）。结论 fPSA 和CEA 是早期诊断前列腺癌的重要线索，两者联合诊 断血清tPSA 低水平升高前列腺癌的效能较好，可能成为更好的前列腺癌早期诊断的新途径。

Abstract:

Objective To analyze the early diagnostic value of free prostate specific antigen (fPSA) combined with carcinoembryonic antigen (CEA) for prostate cancer. Methods A total of 256 patients with suspected prostate cancer who were admitted to our hospital from January 2017 to December 2019 were selected as the research subjects. The serum total prostate specific antigen (tPSA) level of the included participants was between 4.0 and 20.0 μg/L. According to serum tPSA levels, patients were divided into tPSA 4.0 ～ 10.0 μg/L group (180 patients) and tPSA 10.1 ～ 20.0 μg/L group (76 patients). The serum fPSA, CEA levels and ratio of free to total prostatespecific antigen (f/t PSA), and prostate health index (PHI) were compared between the groups. The area under the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of fPSA combined with CEA for prostate cancer. Results In the tPSA 4.0 ～ 10.0 μg/L group, the serum fPSA and CEA levels of prostate cancer patients and non-prostate cancer patients were significantly different (P < 0.05). There was no significant difference in the age, serum tPSA level, f/t PSA, and PHI between prostate cancer patients and non-prostate cancer patients (P > 0.05). In the tPSA 10.1～20.0μg/L group, the serum fPSA, CEA, and PHI of prostate cancer patients were significantly different between prostate cancer patients and non-prostate cancer patients (P < 0.05), while there was no statistically significant difference in the age, serum tPSA level, and f/t PSA between patients with prostate cancer and those without prostate cancer (P > 0.05). According to Pearson correlation analysis, serum fPSA (r = 0.348) and CEA levels (r = 0.392) of prostate cancer patients were positively correlated with PHI (P < 0.05). The linear regression analysis showed serum fPSA levels (b = 0.046) and CEA levels (b = 0.449) were both influencing factors of PHI level (P < 0.05). The ROC curve analysis showed that the AUC of fPSA combined with CEA for the diagnosis of prostate cancer was 0.921, which was significantly greater than 0.672 of fPSA and 0.703 of CEA (P < 0.05). Conclusions Both fPSA and CEA are important indicators for the occurrence of prostate cancer, and the combination of the two has a better efficacy in diagnosing prostate cancer with low serum tPSA levels, which may be a new approach for better early diagnosis of prostate cancer.