MRI联合血清Periostin、SDF-1对前列腺癌的诊断价值研究

Diagnostic value of MRI combined with serum Periostin and SDF-1 for prostate cancer

摘要:

目的 探讨磁共振成像（MRI）联合血清骨膜素（Periostin）、基质细胞衍生因子1（SDF-1）对前列腺癌（PCa）的诊断价值。方法 选取2019年2月—2021年2月宁夏医科大学总医院收治的144例疑似PCa患者，均行手术病理证实。其中PCa患者76例作为PCa组，前列腺良性疾病（BPH）患者68例作为BPH组。酶联免疫吸附试验测定血清Periostin、SDF-1表达水平；受试者工作特征（ROC）曲线分析血清Periostin、SDF-1水平诊断PCa的价值；Kappa检验分析MRI、血清Periostin、SDF-1单独及联合诊断PCa与手术病理结果的一致性。结果 两组患者时间-信号强度曲线类型比较，差异有统计学意义（P <0.05）。PCa组Tmax低于BPH组，最大增强斜率及信号增强率均高于BPH组（P <0.05）。PCa组SDF-1、Periostin水平高于BPH组（P <0.05）。ROC曲线分析结果显示，血清SDF-1水平诊断PCa的最佳截断值为5.91 pg/mL，AUC为0.783（95% CI：0.731，0.873），敏感性、特异性分别为59.21%（95% CI：0.473，0.704）、91.18%（95% CI：0.818，0.967），血清Periostin水平诊断PCa的最佳截断值为37.38 ng/mL，AUC为0.802（95% CI：0.692，0.844），敏感性、特异性分别为64.47%（95% CI：0.527，0.751）、86.76%（95% CI：0.764，0.938）。MRI、SDF-1、Periostin水平与金标准的一致性比较，差异均有统计学意义（P <0.05），与手术病理金标准结果一致较好。MRI联合血清SDF-1、Periostin水平与金标准的一致性比较，差异有统计学意义（P <0.05），与手术病理金标准结果一致性好。MRI、血清SDF-1、Periostin水平联合诊断PCa的准确性、敏感性和阴性预测值最高，分别为90.28%和94.73%（95% CI：0.856，0.984）和93.55%。SDF-1单独诊断PCa的特异性最高，为91.18%（95% CI：0.818，0.967）。MRI、SDF-1单独诊断PCa的阳性预测值最高，均为88.24%。结论 MRI联合血清SDF-1、Periostin在PCa的准确诊断方面具有一定的临床应用价值，可用于PCa的鉴别并避免过度诊断，为前列腺疾病的准确诊断提供参考。

Abstract:

Objective To investigate the diagnostic value of magnetic resonance imaging (MRI) combined with serum Periostin and stromal cell-derived factor-1 (SDF-1) for prostate cancer (PCa).Methods A total of 144 patients with suspected PCa admitted to the General Hospital of Ningxia Medical University from February 2019 to February 2021 were selected. The diagnosis of all patients was confirmed by surgery and pathology, including 76 patients with PCa as the PCa group and 68 patients with benign prostate hyperplasia (BPH) as the BPH group. The serum levels of Periostin and SDF-1 were determined by enzyme-linked immunosorbent assay (ELISA). The diagnostic value of serum levels of Periostin and SDF-1 for PCa was analyzed via receiver operating characteristic (ROC) curve. Kappa test was applied to analyze the consistency of MRI, serum levels of Periostin and SDF-1 alone and their combination with pathological findings in the diagnosis of PCa.Results The time-intensity curve was different between the PCa group and the BPH group (χ² = 36.465, P < 0.05). Compared with the BPH group, the time to peak (Tmax) was lower, and maximum slope of increase (MSI) and signal enhancement rate (SER) were higher in the PCa group (P < 0.05). The serum levels of SDF-1 and Periostin in the PCa group were higher than those in the BPH group (P < 0.05). The ROC curve analysis showed that the optimal cut-off value of the serum level of SDF-1 was 5.91 pg/mL for diagnosing PCa, with the area under the ROC curve (AUC) being 0.783 (95% CI: 0.731, 0.873), the sensitivity being 59.21% (95% CI: 0.473, 0.704) and the specificity being 91.18% (95% CI: 0.818, 0.967), respectively. The optimal cut-off value of the serum level of Periostin was 37.38 ng/mL, with the AUC being 0.802 (95% CI: 0.692, 0.844), the sensitivity being 64.47% (95% CI: 0.527, 0.751) and the specificity being 86.76% (95% CI: 0.764, 0.938), respectively. The analysis on the agreement of MRI and serum levels of SDF-1 and Periostin with the gold standard in diagnosing PCa exhibited significant differences (P < 0.05), demonstrating that the diagnostic results of these indicators were in good agreement with the results of the gold standard surgical pathology. The analysis on the agreement of MRI combined with serum levels of SDF-1 and Periostin with the gold standard also exhibited significant differences (P < 0.05), demonstrating that the diagnostic results of the combined detection were in good agreement with the results of the gold standard surgical pathology as well. The accuracy, sensitivity, and negative predictive value of MRI combined with serum levels of SDF-1 and Periostin for diagnosing PCa were the highest, with them being 90.28%, 94.73 (95% CI: 0.856, 0.984) and 93.55%, respectively. The specificity of SDF-1 alone for diagnosing PCa was the highest, with it being 91.18% (95% CI: 0.818, 0.967). Besides, the positive predictive values of MRI and SDF-1 alone for diagnosing PCa were the highest, with them both being 88.24%.Conclusions MRI combined with serum SDF-1 and Periostin is of value for the accurate diagnosis of PCa in clinical practice, and can be used to identify PCa and to prevent overdiagnosis, thus providing a reference for the accurate diagnosis of prostate diseases.