直肠指检与前列腺穿刺活检结果相关指标关系的研究

摘要

目的：探讨直肠指检（DRE）与前列腺穿刺活检相关指标之间的关系，重新评价直肠指检的意义及必要性。方法：选取天津医科大学第二医院的前列腺穿刺活检患者，统计其DRE结果与前列腺穿刺活检的结果，同时收集年龄、前列腺特异性抗原（PSA）、前列腺体积（PV）、PSA密度（PSAD）及前列腺癌患者的Gleason评分、骨扫描、局部侵犯神经情况，分析其与直肠指检之间的意义。结果：总计457例患者纳入研究，其中穿刺阳性患者223例，阴性患者234例；DRE阳性患者99例，阴性患者358例。良性与恶性患者的DRE检查结果比较，差异有统计学意义（P<0.001）。DRE阳性和阴性患者的Gleason评分、骨转移、PSA、PSAD、阳性针数占比比较，差异均有统计学意义（P=0.045、P=0.044、P<0.001、P<0.001、P=0.021）；而年龄、f/t PSA、前列腺体积、局部神经侵犯方面比较，差异均无统计学意义（P=0.772、0.316、0.322、0.521）。结论：直肠指检仍然是前列腺癌筛查的重要手段，其阳性与前列腺癌恶性程度有显著的相关性，临床医师在依赖其他先进检查的同时，也应对传统的直肠指检保持重视。%Objective:To explore the relationship between digital rectal examination(DRE)and prostate biopsy results,and to re-evaluate the significance and necessity of DRE. Method:Patients who had prostate biopsy in the Second Hospital of Tianjin Medical University were included in this study,the results of DRE and prostate biopsy were statistically analyzed.The ages,PSA,prostate volume(PV),f/t PSA,PSA density(PSAD)were investigated,the Gleason scores,ECT bone scan results,local neural invasion results of prostate cancer(PCa) patients were collected meanwhile.The relationship between DRE and other results were analyzed.Result:A total of 457 patients were included in the study,223 patients were diagnosed as PCa and 234 patients got negative results in the biopsy,99 patients got positive DRE results,358 patients got negative DRE results. The results of DRE in patients with benign and malignant were compared,the difference was statistically significant(P<0.001). Gleason score,bone metastasis,PSA,PSAD,positive needle number accounting of DRE positive and negative patients were compared,the differences were statistically significant(P=0.045,P=0.044,P<0.001,P<0.001, P=0.021).And for the age,f/t PSA,PV,local neural invasion of the two groups,the differences were not statistically significant(P=0.772,0.316,0.322,0.521).Conclusion:Digital rectal examination is still an important means of screening for prostate cancer,there is a significant correlation between the positive and the degree of malignancy of prostate cancer.While clinicians rely on other advanced inspection,the traditional DRE should also be kept attention at the same time.