【摘要】 目的:使用前列腺影像报告和数据系统(prostate imaging reporting and data system, PI-RADS)和中性粒细胞校正前列腺特异性抗原(prostate-specific antigen, PSA)相关指标，评估其在前列腺癌中的诊断潜力，并探讨它们在前列腺免穿刺活检中的潜在应用价值。方法:收集2018年1月—2023年1月陕西省人民医院收治的546例总前列腺特异性抗原(total prostate-specific antigen, tPSA)>4 ng/mL或直肠指检和经直肠前列腺穿刺活检发现异常的患者的临床资料，单因素、多因素及受试者操作特征(receiver operating characteristic, ROC)曲线分析年龄、tPSA、前列腺体积(prostate volume, PV)、中性粒细胞计数(neutrophil count, NC)、PI-RADS及对tPSA进行校正后得到的4个变量：前列腺特异性抗原密度(prostate-specific antigen density, PSAD)、tPSA-中性粒细胞比值(tPSA to neutrophil ratio, PNR)、PSAD-中性粒细胞比值(PSAD to neutrophil ratio, PDNR)、PSAD联合PI-RADS-中性粒细胞比值(PSAD combined with PI-RADS to neutrophil ratio, PDPNR)对前列腺癌的诊断价值，并分析它们在前列腺免穿刺活检中的价值。结果:tPSA通过PV、NC和PI-RADS评分的校正提高了对前列腺癌的诊断价值(PDPNR>PDNR>PSAD>PNR>tPSA)。此外，当阴性预测值到达100%时，tPSA的特异度仅为0.75%,PDNR的特异度最高，为22.39%。当阳性预测值到达100%时，tPSA的特异度仅为13.79%,PDPNR的灵敏度最高，为29.31%。结论:校正的tPSA变量提高了前列腺癌的诊断性能，减少了不必要的穿刺和患者负担(心理负担、穿刺疼痛和经济负担),为进一步的前瞻性研究提供了理论依据。更多还原

【Abstract】 Objective: To utilize PI-RADS and neutrophils to correct PSA-related indexes, evaluate their diagnostic potential in prostate cancer, and discuss their role in prostate cancer without prior biopsy. Methods: From January 2018 to January 2023, we collected the clinical data of 546 cases with tPSA >4 ng/mL or abnormal findings by digital rectal examination and transrectal prostate biopsy. The age, tPSA, PV(prostate volume), NC(neutrophil count) and PI-RADS were analyzed by univariate, multivariate and ROC curves, and four variables PSAD(prostate-specific antigen density), PNR(tPSA to neurophil ratio), PDNR(PSAD to neurophil ratio) and PDPNR(PSAD combined with PI-RADS to neutrophil ratio) were obtained after correcting tPSA. The diagnostic values of PSAD, PNR, PDNR and PDPNR for prostate cancer without prior biopsy were analyzed. Results: It was found that PSA improved the diagnostic value of prostate cancer through the correction of PV, NC and PI-RADS scores(PDPNR>PDNR>PSAD>PNR>tPSA). In addition, when the negative predictive value reached 100%, the specificity of tPSA was only 0.75%, and the specificity of PDNR was the highest(22.39%). When the positive predictive value reached 100%, the specificity of tPSA was only 13.79%, and the sensitivity of PDPNR was the highest(29.31%). Conclusion: Modifying tPSA variable improves the diagnostic performance of prostate cancer, reduces unnecessary puncture and patient burden(psychological burden, puncture pain and economic burden), and provides theoretical basis for further prospective research.更多还原