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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、χ2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PSAD≥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 investigate the detection of prostate cancer by different serum PSA levels and the significance of screening prostatic biopsy cases such as digital rectal examination (DRE), transrectal ultrasound examination (TRUS) and PSA density (PSAD). Methods The diagnostic data of 634 patients who underwent TRUS guided prostatic 6-point needle biopsy from April 1996 to December 2002 were retrospectively analyzed. The changes in the PSA levels (≤4.0, 4.1 ~, 10.1 ~ and> 20.0 μg / L group), and the predictive value of PSA, DRE, TRUS and PSAD on prostate cancer were analyzed by t test, χ2 test and multivariate logistic regression analysis. Results The detection rates of prostate cancer were 11.6% (17/146), 26.8% (38/142) and 39.8% (68/171) in PSA ≤ 4.0, 4.1 ~, 10.1 ~ and> 20.0 μg / 68.6% (120/175). Sensitivity of PSA was the highest (93.0%) and specificity was low (33.0%). DRE and TRUS were less effective in diagnosis. With the increase of serum PSA level, the detection rate of prostate cancer and the positive predictive value of DRE and TRUS gradually increased; in PSA4.1 ~ 20.0μg / L, PSAD had a greater predictive value for prostate cancer (OR = 687.09 ± 646.96, P = 0.000). To PSAD ≥ 0.13μg.L-1.cm-3 as the cut-off point of prostate biopsy cases, can not significantly reduce the sensitivity of the foundation, reducing the negative puncture. Conclusions The detection rates of prostate cancer in each PSA group are different from those in Europe, America and other countries. The screening effect of DRE and TRUS is related to the level of serum PSA. The screening of the puncture cases by PSA level can improve the positive rate of prostate biopsy.