磁共振成像联合血清SDF-1、f-PSA/t-PSA、HE4对前列腺癌的诊断价值分析

Diagnostic value of magnetic resonance imaging combined with serum SDF-1, f-PSA/t-PSA ratio, and HE4 in prostate cancer

摘要:

目的 探究磁共振成像（MRI）联合血清基质细胞衍生因子1（SDF-1）、游离前列腺特异性抗原与总前列腺特异性抗原比值（f-PSA/t-PSA）、人附睾蛋白4（HE4）对前列腺癌（PCa）的诊断价值。方法 选取2022年10月—2024年10月于汉中市中心医院就诊的128例前列腺癌（PCa）患者设为PCa组，并选取同期该院50例经病理确诊的前列腺增生患者作为对照组。比较两组MRI定量参数及血清SDF-1、HE4水平与f-PSA/t-PSA的差异。采用多因素一般Logistic回归模型分析PCa的影响因素并构建列线图。绘制受试者工作特征（ROC）曲线分析MRI联合血清SDF-1、f-PSA/t-PSA、HE4对PCa的诊断价值。结果 PCa组的容量转移常数（K^trans）、速率常数（K_ep）、血管外细胞外间隙容积分数（V_e）均高于对照组（P <0.05），表观弥散系数（ADC）低于对照组（P <0.05）。PCa组的SDF-1、HE4水平均高于对照组（P <0.05），f-PSA/t-PSA低于对照组（P <0.05）。多因素一般Logistic回归分析结果显示：ADC低［O^R =0.478（95% CI：0.255，0.895）］、K^trans高［O^R =2.114（95% CI：1.076，4.156）］、K_ep高［O^R =2.465（95% CI：1.106，5.497）］、V_e高［O^R =2.541（95% CI：1.199，5.388）］、SDF-1高［O^R =6.002（95% CI：2.725，13.223）］、f-PSA/t-PSA低［O^R =0.434（95% CI：0.236，0.798）］、HE4高［O^R =3.335（95% CI：1.300，8.554）］均为PCa的危险因素（P <0.05）。ROC曲线分析结果表明，ADC、K^trans、K_ep、V_e、SDF-1、f-PSA/t-PSA、HE4联合预测的曲线下面积为0.984（95% CI：0.970，0.998），敏感性为95.3%（95% CI：0.901，0.983），特异性为98.0%（95% CI：0.894，0.999）。结论 MRI联合血清SDF-1、f-PSA/t-PSA、HE4对PCa具有良好的诊断价值。

Abstract:

Objective To investigate the diagnostic value of magnetic resonance imaging (MRI) combined with serum stromal cell-derived factor-1 (SDF-1), free prostate-specific antigen (PSA) to total PSA ratio (f-PSA/t-PSA), and human epididymis protein 4 (HE4) in prostate cancer (PCa).Methods A total of 128 PCa patients admitted to the Hanzhong Central Hospital from October 2022 to October 2024 were enrolled as the PCa group, while 50 patients with benign prostatic hyperplasia were selected as the control group. MRI quantitative parameters and serum levels of SDF-1, f-PSA/t-PSA, and HE4 were compared between the two groups. Logistic regression analysis was used to identify influencing factors of PCa and construct a nomogram. Receiver operating characteristic (ROC) curves were generated to analyze the diagnostic efficacy of MRI combined with serum markers.Results The volume transfer constant (K^trans), rate constant (K_ep), and extracellular extravascular volume fraction (V_e) in the PCa group were significantly higher than those in the control group, while the apparent diffusion coefficient (ADC) was significantly lower (P < 0.05). The levels of SDF-1 and HE4 in the PCa group were higher than those in the control group, while the f-PSA/t-PSA ratio was lower than that in the control group (P < 0.05). Multivariate logistic regression analysis revealed that low ADC level [O^R = 0.478 (95% CI: 0.255, 0.895) ], high K^trans [O^R = 2.114 (95% CI: 1.076, 4.156) ], high K_ep [O^R = 2.465 (95% CI: 1.106, 5.497) ], high V_e [O^R = 2.541 (95% CI: 1.199, 5.388) ], high SDF-1 [O^R = 6.002 (95% CI: 2.725, 13.223) ], low f-PSA/t-PSA ratio [O^R = 0.434 (95% CI: 0.236, 0.798) ], and high HE4 [O^R = 3.335 (95% CI: 1.300, 8.554) ] were all independent risk factors for PCa (P < 0.05). ROC analysis demonstrated that the combined predictive model incorporating ADC, K^trans, K_ep, V_e, SDF-1, f-PSA/t-PSA, and HE4 achieved area under the curve of 0.984（95% CI：0.970，0.998）, with a sensitivity of 95.3% (95% CI: 0.901, 0.983) and a specificity of 98.0% (95% CI: 0.894, 0.999).Conclusion MRI combined with serum SDF-1, f-PSA/t-PSA ratio, and HE4 has good diagnostic value for prostate cancer.