性激素、前列腺特异性抗原及其相关参数对前列腺癌的诊断价值

摘要

目的 探讨前列腺癌(PCa)患者血清性激素睾酮(T)、雌二醇(E2)、孕酮(P)、卵泡刺激素(FSH)、黄体生成素(LH)及泌乳素(PRL)和前列腺特异性抗原(PSA)的水平及其对PCa的诊断价值.方法 选取2012年10月～2016年12月承德医学院附属医院诊治的PCa患者30例、良性前列腺增生症(BPH)患者45例及健康体检者45例,分别作为PCa组、BPH组和正常对照组,检测各组性激素六项(T、E2、P、FSH、LH、PRL)和PSA水平,采用ROC曲线评估各检测指标对PCa的诊断价值.结果 与BPH组、正常对照组比较,PCa组T明显降低,而FSH、LH明显增高(P＜ 0.05);E2、P、PRL差异无统计学意义(P＞0.05).BPH组与正常对照组比较,各项性激素水平差异无统计学意义(P＞0.05).PCa组和BPH组患者血清总PSA(TPSA)、游离PSA(FPSA)、PSA密度(PSAD)较正常对照组明显增高,而FPSA与TPSA比值(F/T)明显降低(P＜ 0.05);PCa组患者血清TPSA、FPSA、PSAD较BPH组患者明显增高,而F/T明显降低(P＜0.05).TPSA、FPSA、PSAD、T、FSH、LH的ROC曲线下面积(AROC)分别为1.000、0.894、0.991、0.920、0.753、0.868;各检测参数AROC比较,TPSA＞PSAD＞T＞FPSA＞LH＞FSH,其中TPSA和PSAD、FPSA和T、FPSA和LH、PSAD和T、T和LH、FSH和LH配对比较,差异无统计学意义(P＞0.05);其余配对比较,差异有统计学意义(均P＜ 0.05).结论 PCa患者血清T水平降低,FSH、LH水平增高.性激素及血清PSA联合检测有助于PCa的早期诊断.%Objective To explore serum sex hormone T,FSH,LH,E2,P,PRL,PSA levels and evaluate the diagnostic value of the patients with prostate cancer (PCa).Methods 30 patients with PCa (PCa group),45 cases of benign prostatic hyperplasia (BPH group) and 45 medical normal cases (control group) were selected to examine the six indicators of sex hormone (T,FSH,LH,E2,P,PRL) and PSA levels from the Affiliated Hospital of Chengde Medical College from October 2012 to December 2016.The diagnostic value of each parameter to detect PCa was assessed by the receiver operating characteristic (ROC) curve.Results Compared with the BPH group and control group,the serum T level in PCa group was significantly decreased,while FSH and LH were significantly increased (P ＜ 0.05),E2,P,PRL levels were no significant differences (P ＞ 0.05).Compared with the control group,the various sex hormone levels in BPH group were no significant differences (P ＞ 0.05).Compared with the control group,the serum total PSA (TPSA),free PSA (FPSA) and PSA density (PSAD) in PCa group and BPH group were significantly increased,while F/T was significantly decreased (P ＜ 0.05).Compared with the BPH group,the serum TPSA,FPSA and PSAD in patients with PCa group were significantly increased,while F/T was significantly decreased (P ＜ 0.05).The areas under the ROC curves (AROC) of TPSA,FPSA,PSAD,T,FSH and LH were 1.000,0.894,0.991,0.920,0.753,0.868.The testing parameters AROC comparison from big to small for TPSA,PSAD,T,FPSA,LH and FSH,differences between TPSA and PSAD,FPSA and T,FPSA and LH,PSAD and T,T and LH,FSH and LH were no statistically significance (P ＞ 0.05).The remaining differences between paired were statistically significant (P ＜ 0.05).Conclusion The serum T level in patients with PCa is decreased but FSH and LH levels are increased.The combined detection of sex hormone and serum PSA is a valuable early diagnostic tool for PCa.