【摘要】：目的:分析經(jīng)直腸前列腺穿刺活檢前列腺癌陽性率的預(yù)測因素。方法:總結(jié)2006年1月至2014年4月進行經(jīng)直腸超聲引導(dǎo)下前列腺穿刺活檢患者的資料,包括年齡(age)、體質(zhì)指數(shù)(BMI)、癥狀(syptoms)、直腸指檢(DRE)、血清總PSA(t PSA)、游離PSA(f PSA)、游離PSA與總PSA比值(f/t PSA)、前列腺體積(PV)、PSA密度(PSAD)。通過單因素方差分析和多因素回歸模型,篩選與活檢陽性率相關(guān)的危險因素。在此基礎(chǔ)上構(gòu)建一個評分系統(tǒng)作為在活檢前預(yù)測前列腺癌陽性率的工具,并通過受試者工作特征(ROC)曲線計算假陽性率,以檢測評分系統(tǒng)的敏感性。結(jié)果:在385例經(jīng)直腸超聲引導(dǎo)下穿刺活檢患者中,共139例患者被診斷為前列腺癌,陽性率36.1%。單因素分析顯示,在活檢陽性組和陰性組之間,年齡(P0.01)、DRE(P0.01)、t PSA(P0.01)、f PSA(P0.01)、f/t PSA(P0.01)、PV(P0.01)和PSAD(P0.01)在前列腺癌患者中比例均高于活檢陰性人群。將單因素回歸有意義的因素納入多因素逐步Logistic分析,結(jié)果顯示,年齡、t PSA、f/t PSA、PV和PSAD是經(jīng)直腸反復(fù)前列腺活檢陽性的獨立影響因素,其比值比(ORs)及其相應(yīng)的95%可信區(qū)間(95%CIs)分別為1.07(1.05~1.16)、1.05(1.02~1.15)、0.97(0.86~0.99)、0.98(0.87~0.96)和1.79(1.48~2.06)。根據(jù)其OR值,設(shè)定年齡71歲(中位數(shù))、t PSA14.1μg/L(中位數(shù))、f/t PSA14.07(中位數(shù))、PV42.8 ml(中位數(shù))、PSAD0.31μg/L/ml(中位數(shù))分別各計1分,總分為5分。將385例患者的資料通過評分系統(tǒng)計算前列腺癌的檢出率,發(fā)現(xiàn)評分為0、1、2、3、4、5分的患者前列腺癌的檢出率分別為7.69%、8.98%、15.19%、39.39%、54.55%和72.15%。ROC曲線提示曲線下面積為0.82(95%CI:0.80~0.84,P0.01)。另外,評分3~5分的患者比0~2分的患者前列腺癌的檢出率高50%以上(64%vs 11%,P0.01)。結(jié)論:該評分系統(tǒng)可以幫助泌尿科醫(yī)師確定需要行前列腺活檢的患者。
[Abstract]:Objective: to analyze the predictive factors of prostate cancer positive rate by transrectal prostate biopsy. Methods: data of patients undergoing transrectal ultrasound guided prostate biopsy from January 2006 to April 2014 were summarized, including age (age), body mass index (BMI),) symptoms, (syptoms), rectal finger biopsy (DRE), total serum PSA (t PSA),. Free PSA (f PSA), ratio of free PSA to total PSA (f / t PSA), (PV), PSA density (PSAD).) Single factor analysis of variance (ANOVA) and multivariate regression model were used to screen the risk factors associated with positive rate of biopsy. On this basis, a scoring system was constructed as a tool to predict the positive rate of prostate cancer before biopsy, and the false positive rate was calculated by the (ROC) curve of the subjects' operating characteristics to detect the sensitivity of the scoring system. Results: of 385 patients with transrectal ultrasound guided biopsy 139 patients were diagnosed with prostate cancer and the positive rate was 36.1%. Univariate analysis showed that age (P0.01), DRE (P0.01), t PSA (P0.01), f PSA (P0.01), frt PSA (P0.01) between positive and negative biopsy group, The proportion of PV (P0.01) and PSAD (P0.01) in prostate cancer patients was higher than that in biopsy negative patients. Univariate regression significant factors were included in multivariate stepwise Logistic analysis. The results showed that age, t PSA,f/t PSA,PV and PSAD were independent influencing factors of prostate biopsies positive through rectum. The ratio of (ORs) and its corresponding 95% confidence interval (95%CIs) were 1.07 (1.05-1.16), 1.05 (1.02v 1.15), 0.97 (0.860.99), respectively. 0.98 (0.870.96) and 1.79 (1.482.06). According to their OR values, the set age of 71 years (median), t PSA14.1 渭 g / L), f / t PSA14.07 (median), PV42.8 ml (median) and PSAD0.31 渭 g/L/ml (median) were 1, respectively, with a total score of 5. The detection rate of prostate cancer was calculated by a scoring system in 385 patients. It was found that the detection rate of prostate cancer with a score of 0 1 / 2 or 3 / 4 and 5 / 5 was 7.69 / 8.98 / 15.19 and 39.39, respectively. The area under the curve indicated by 54.55% and 72.15%.ROC curve was 0.82. In addition, the detection rate of prostate cancer in patients with 3 ~ 5 scores was more than 50% higher than that with 0 ~ 2 scores (64%vs 11 / P0.01). Conclusion: this scoring system can help urologists identify patients who need prostate biopsies.
【作者單位】： 南通市第一人民醫(yī)院泌尿外科;東南大學(xué)附屬中大醫(yī)院泌尿外科;
【分類號】：R737.25

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