【摘要】 目的 观察灰区前列腺癌[前列腺特异性抗原(prostate specific antigen, PSA)4～10μg/L]患者PI-RADS v2.1评分及PSA衍生指标水平，探讨二者联合对灰区前列腺癌的诊断价值。方法 116例前列腺疾病患者均行前列腺穿刺活检病理检查，其中前列腺癌33例为前列腺癌组，良性前列腺增生或前列腺炎83例为非前列腺癌组。2组前列腺穿刺活检前均行前列腺多参数MRI检查，对MRI图像行PI-RADS v2.1评分。采用电化学发光法检测总PSA(total PSA, tPSA)、游离PSA(free PSA, fPSA)水平，计算f/tPSA(fPSA/tPSA)。比较2组年龄、tPSA、fPSA、f/tPSA、前列腺体积、PSA密度(PSA density, PSAD)及PI-RADS v2.1评分。采用多因素logistic回归分析诊断灰区前列腺癌的影响因素。绘制ROC曲线，评估PSAD、PI-RADS v2.1评分单独及联合诊断灰区前列腺癌的效能。结果 前列腺癌组f/tPSA[0.13(0.12, 0.20)]低于非前列腺癌组[0.18(0.13, 0.24)](Z=-2.181,P=0.029),前列腺体积[33.06(23.12, 48.10)cm~3]小于非前列腺癌组[54.31(38.08, 71.45)cm~3](Z=-3.592,P<0.001),PSAD[0.22(0.14, 0.29)μg/(L·cm~3)]、PI-RADS v2.1评分[4(3, 5)分]均高于非前列腺癌组[0.13(0.10, 0.19)μg/(L·cm~3)、2(2, 3)分](Z=-3.675,P<0.001;Z=-5.071,P<0.001)。PSAD(OR=737.385,95%CI:5.266～103 255.995,P=0.009)、PI-RADS v2.1评分(OR=2.685,95%CI:1.713～4.207,P<0.001)是诊断灰区前列腺癌的独立影响因素。PSAD、PI-RADS v2.1评分分别以0.24μg/(L·cm~3)、4分为最佳截断值，单独及联合诊断灰区前列腺癌的AUC分别为0.719(95%CI:0.612～0.827,P<0.001)、0.789(95%CI:0.689～0.889,P<0.001)、0.832(95%CI:0.742～0.923,P<0.001),灵敏度分别为45.5%、69.7%、87.9%,特异度分别为91.6%、83.1%、73.5%。结论 灰区前列腺癌患者PSAD、PI-RADS v2.1评分增高，PSAD和PI-RADS v2.1评分联合诊断灰区前列腺癌的价值较高。更多还原

【Abstract】 Objective To observe the changes of PI-RADS v2.1score and the prostate specific antigen(PSA)derivative indicators of prostate cancer in gray-zone PSA (PSA:4-10μg/L),and to investigate the value of the combination of them two to the diagnosis of prostate cancer in gray-zone PSA.Methods Totally 116patients with prostate diseases underwent prostate needle biopsy for histopathology examination,and were divided into 33patients with prostate cancer(prostate cancer group)and 83 patients with benign prostate hyperplasia or prostatitis (non-prostate cancer group).Multiparametric MRI was performed before prostate biopsy,and MRI images were analyzed by PI-RADS v2.1score.The levels of total PSA (tPSA)and free PSA (fPSA)were measured by electrochemiluminescence,and f/tPSA was calculated.The age,tPSA,fPSA,f/tPSA,prostate volume,PSA density (PSAD)and PI-RADS v2.1score were compared between two groups.Multivariate logistic regression was done to analyze the influencing factors of prostate cancer in gray-zone PSA.ROC curves were drawn to evaluate the efficiencies of single and combined application of PSAD score and PI-RADS v2.1on diagnosing prostate cancer in gray-zone PSA.Results The f/tPSA was lower in prostate cancer group[0.13(0.12,0.20)]than that in non-prostate cancer group[0.18(0.13,0.24)](Z=-2.181,P=0.029).Prostate volume was smaller in prostate cancer group[33.06(23.12,48.10)cm~3]than that in non-prostate cancer group[54.31(38.08,71.45)cm~3](Z=-3.592,P<0.001).The PSAD and PI-RADS v2.1score were higher in prostate cancer group[0.22(0.14,0.29）μg/（L·cm~3),4(3,5)]than those in non-prostate cancer group[0.13(0.10,0.19）μg/（L·cm~3),2(2,3)](Z=-3.675,P<0.001;Z=-5.071,P<0.001).The PSAD(OR=737.385,95%CI:5.266-103 255.995,P=0.009)and PI-RADS v2.1score(OR=2.685,95%CI:1.713-4.207,P<0.001)were the independent influencing factors of prostate cancer in gray-zone PSA.When the optimal cut-off values of PSAD and PI-RADS v2.1score were 0.24μg/（L·cm~3)and 4,the AUCs of single and combined application of them two for diagnosing prostate cancer in gray-zone PSA were 0.719(95%CI:0.612-0.827,P<0.001),0.789(95%CI:0.689-0.889,P<0.001),and 0.832(95%CI:0.742-0.923,P<0.001),the sensitivities were 45.5%,69.7%and 87.9%,and the specificities were 91.6%,83.1%and 73.5%,respectively.Conclusion PSAD and PI-RADS v2.1score increase in patients with prostate cancer in gray-zone PSA,and the combination of them two has a high diagnostic value.更多还原