本文選題：紅細(xì)胞分布寬度 + 前列腺腫瘤��； 參考：《蘇州大學(xué)》2016年碩士論文

【摘要】：前列腺癌(PCa)是發(fā)生于男性中的一種常見(jiàn)惡性腫瘤,好發(fā)于老年男性且發(fā)病隱匿,嚴(yán)重威脅著老年男性的身體健康。目前PCa的發(fā)病危險(xiǎn)因素尚未明確,臨床上用于診斷PCa的基本方法有前列腺特異性抗原(PSA)檢查、直腸指檢和經(jīng)直腸超聲檢查,而經(jīng)直腸超聲檢查引導(dǎo)下的前列腺穿刺活檢是PCa的診斷金標(biāo)準(zhǔn)。隨著前列腺惡性腫瘤疾病篩查的普及,前列腺穿刺活檢患者的數(shù)量越來(lái)越多,然而我國(guó)前列腺穿刺活檢陽(yáng)性率相對(duì)較低,導(dǎo)致了一些患者不必要的前列腺穿刺活檢。因此,研究影響前列腺穿刺活檢結(jié)果的相關(guān)指標(biāo),明確前列腺穿刺活檢陽(yáng)性的相關(guān)因素,提高前列腺穿刺活檢陽(yáng)性率具有極大的科研及臨床意義。本研究分兩個(gè)部分:第一部分我們分析了前列腺穿刺活檢患者的紅細(xì)胞分布寬度(RDW),比較穿刺陽(yáng)性和穿刺陰性患者RDW的差異,探討在前列腺穿刺活檢患者中測(cè)定RDW的臨床意義;第二部分,我們測(cè)定了前列腺穿刺活患者的前列腺干細(xì)胞抗原(PSCA)rs1045531多態(tài)性,初步研究了PSCA單核苷酸多態(tài)性(SNP)在前列腺穿刺活檢患者中的臨床意義。第一部分前列腺穿刺活檢患者中紅細(xì)胞分布寬度測(cè)定的臨床意義目的:探討紅細(xì)胞分布寬度(RDW)在前列腺穿刺活檢患者中的臨床意義。方法:分析比較前列腺穿刺活檢患者穿刺病理結(jié)果為前列腺癌(PCa)和良性前列腺增生(BPH)患者間RDW、前列腺特異性抗原(PSA)、血紅蛋白(HB)、血白細(xì)胞(WBC)、血小板(PLT)、甘油三酯(TG)和年齡的差異,Logistic回歸分析RDW、PSA、HB和年齡對(duì)前列腺穿刺陽(yáng)性的影響。運(yùn)用受試者工作特性(ROC)曲線分析比較RDW在不同PSA時(shí)對(duì)前列腺穿刺陽(yáng)性的影響。運(yùn)用方差分析和Spearman等級(jí)相關(guān)分析來(lái)分析比較RDW與PCa患者PSA、Gleason評(píng)分及臨床分期的關(guān)系。依據(jù)2002 AJCC TNM classification將早期PCa(≤T2N0M0)患者篩選出,剔除中晚期PCa患者,重新對(duì)RDW與穿刺陽(yáng)性關(guān)系進(jìn)行統(tǒng)計(jì)學(xué)分析,本研究中早期PCa特指臨床局限性PCa。結(jié)果:PCa患者RDW[(13.38±1.11)%,359例]高于BPH患者[(12.75±0.62)%,434例],差異有統(tǒng)計(jì)學(xué)顯著意義(P0.001),RDW是前列腺穿刺陽(yáng)性的獨(dú)立影響因素,明顯優(yōu)于年齡和PSA(OR值分別為2.440、1.061和1.017)。PSA20ng/ml組患者ROC曲線下面積(AUCRDW)明顯高于PSA10ng/ml組和PSA(10~20ng/ml)組,三組的AUCRDW分別為0.730(P0.05)、0.560(P0.05)和0.639(P0.05)。PCa患者不同PSA組、Gleason評(píng)分組及臨床分期之間的RDW差異分別都具有統(tǒng)計(jì)學(xué)意義(P0.05),并且隨著疾病危險(xiǎn)度越高,RDW值越大。并進(jìn)一步行RDW與早期PCa的Logistic回歸分析,結(jié)果顯示RDW作為早期PCa的獨(dú)立影響因素,OR值達(dá)到最高的2.547(P0.001)。結(jié)論:1、RDW在PCa患者中高于BPH患者,RDW是前列腺穿刺陽(yáng)性的獨(dú)立影響因子。2、RDW可用于預(yù)測(cè)前列腺穿刺陽(yáng)性,尤其是PSA20ng/ml的穿刺患者。3、RDW分別與PSA、Gleason評(píng)分及臨床分期都呈正相關(guān),可用于評(píng)估PCa危險(xiǎn)程度。4、RDW判斷早期PCa時(shí)OR值最高,對(duì)臨床上PCa的早發(fā)現(xiàn)具有重要意義。第二部分前列腺穿刺活檢患者中前列腺干細(xì)胞抗原SNP的初步研究目的:研究前列腺穿刺活檢患者中前列腺干細(xì)胞抗原(PSCA)基因單核苷酸多態(tài)性(SNP)與前列腺癌(PCa)的相關(guān)性。方法:分析研究前列腺穿刺活檢患者的PSCA rs1045531的多態(tài)性,比較PCa和良性前列腺增生(BPH)患者間rs1045531基因型分布頻率的差異,并分析該基因多態(tài)性與穿刺患者年齡、前列腺特異性抗原(PSA)和Gleason評(píng)分的相關(guān)性。結(jié)果:PCa組(67例)與BPH組(77例)患者的PSCA rs1045531基因型分布頻率差異具有統(tǒng)計(jì)學(xué)意義(P=0.036)。與CC型基因相比,AC型基因顯著增加PCa的患病風(fēng)險(xiǎn)(OR=2.383,95%CI=1.198-4.741,P=0.013)。進(jìn)一步分析rs1045531基因多態(tài)性與穿刺患者年齡、PSA和Gleason評(píng)分的關(guān)系,分析結(jié)果顯示在所有前列腺穿刺活檢患者中rs1045531 AC型患者PSA(53.49±29.24ng/ml)明顯高于CC型(22.42±18.74ng/ml)(P=0.019);在PCa患者中AC型患者PSA(69.89±53.00ng/ml)也明顯高于CC型的PSA(24.40±11.73ng/ml)(P=0.025)。結(jié)論:PSCA rs1045531 AC型基因與PCa的發(fā)病風(fēng)險(xiǎn)相關(guān),且與前列腺穿刺活檢患者的PSA相關(guān),可用于PCa的發(fā)病預(yù)測(cè)和預(yù)后評(píng)估。
[Abstract]:Prostate cancer (PCa) is a common malignant tumor occurring in men. It occurs in old men and is concealed. It is a serious threat to the health of old men. The risk factors of PCa are not clear. The basic methods used for diagnosis of PCa are prostate specific antigen (PSA), rectal examination and transrectal ultrasound The prostate biopsy guided by rectal ultrasound is the diagnostic gold standard for PCa. With the prevalence of prostate cancer screening, the number of patients with prostate biopsy is increasing, but the positive rate of prostate biopsy in our country is relatively low, leading to unnecessary prostate biopsy in some patients. Therefore, it is of great scientific and clinical significance to study the related factors affecting the results of prostate biopsy, to clarify the related factors of positive prostate biopsy and to improve the positive rate of prostate biopsy. This study is divided into two parts: in the first part, we analyzed the red cell distribution width (RDW) of the prostate biopsy patients, and compared the results. The difference in RDW between positive puncture and puncture negative patients was discussed. The clinical significance of measuring RDW in prostate biopsy patients was discussed. The second part, we measured the prostate stem cell antigen (PSCA) rs1045531 polymorphism of prostate biopsy patients, and preliminarily studied the presence of PSCA monoside polymorphism (SNP) in prostate biopsy patients. Clinical significance of the measurement of red cell distribution width in the first part of the prostate biopsy: the clinical significance of the red cell distribution width (RDW) in the patients with prostate biopsy. Methods: analysis and comparison of the pathological results of prostate biopsy patients for prostate cancer (PCa) and benign prostatic hyperplasia (BPH) RDW, prostate specific antigen (PSA), hemoglobin (HB), blood leukocyte (WBC), platelets (PLT), triglyceride (TG) and age differences. Logistic regression analysis of the effects of RDW, PSA, HB and age on prostatic puncture positive effects. The effects of RDW on prostate biopsy positive effects were compared with the subjects' working characteristics (ROC) curve. The relationship between RDW and PCa patients' PSA, Gleason score and clinical staging was analyzed by variance analysis and Spearman grade correlation analysis. According to 2002 AJCC TNM classification, the early PCa (< < < < T2N0M0) patients were screened out and the middle and late PCa patients were eliminated, and the relationship between RDW and puncture positive was statistically analyzed. The results of clinical limited PCa.: RDW[(13.38 + 1.11)% of PCa patients, 359 Cases, higher than BPH patients [(12.75 + 0.62)%, 434], the difference was statistically significant (P0.001), RDW was an independent influence factor of prostate biopsy positive, obviously superior to age and PSA (OR value respectively 2.440,1.061 and 1.017).PSA20ng/ml group under ROC curve area (AUCRDW) Ming Compared with group PSA10ng/ml and PSA (10~20ng/ml), AUCRDW in three groups was 0.730 (P0.05), 0.560 (P0.05) and 0.639 (P0.05).PCa were in different PSA groups. The RDW difference between the Gleason score group and the clinical stage was statistically significant (P0.05), and the higher the risk of the disease, the greater the value. Ogistic regression analysis showed that RDW was the independent influence factor of early PCa, and the OR value reached the highest 2.547 (P0.001). Conclusion: 1, RDW is higher in PCa patients than those of BPH, RDW is an independent influence factor of prostate puncture positive factor.2, RDW can be used to predict prostatic puncture positive, especially for PSA20ng/ml puncture patients. N score and clinical staging are positive correlation, can be used to evaluate the risk of PCa.4, RDW is the highest at early PCa, and it is of great significance for the early detection of PCa in clinical. Second preliminary study of prostate stem cell antigen SNP in prostate biopsy patients: the study of prostate stem cell resistance in prostate biopsy patients. The correlation between the original (PSCA) gene single nucleotide polymorphism (SNP) and prostate cancer (PCa). Methods: analyze the polymorphism of PSCA rs1045531 in prostate biopsy patients and compare the difference in the frequency of rs1045531 genotype distribution between PCa and benign prostatic hyperplasia (BPH) patients, and analyze the polymorphism of the gene and the age of the puncture patient and the prostate special. Correlation between heterosexual antigen (PSA) and Gleason score. Results: the difference in the distribution frequency of PSCA rs1045531 genotypes in group PCa (67 cases) and BPH group (77 cases) was statistically significant (P=0.036). Compared with CC gene, the AC type gene significantly increased the risk of PCa (OR= 2.383,95%CI=1.198-4.741,). The relationship between sex and age, PSA and Gleason scores, the results showed that in all patients with rs1045531 AC, PSA (53.49 + 29.24ng/ml) was significantly higher than that of the CC type (22.42 + 18.74ng/ml) (P=0.019), and PSA (69.89 +, 24.40) was significantly higher in PCa patients. 25). Conclusion: the PSCA rs1045531 AC gene is associated with the risk of PCa and is associated with the PSA of prostate biopsy patients, and can be used to predict the incidence and prognosis of PCa.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R737.25

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