总前列腺特异性抗原在4～10ng/ml水平时前列腺穿刺活检的诊断效能及结果

摘要

目的 探究总前列腺特异性抗原(t-PSA)在4～10 ng/ml时,前列腺穿刺活检的诊断效能及结果.方法 检索2010年1月至2017年3月PubMed、MEDLINE等英文数据库及中国知网、万方数据等中文数据库中t-PSA 4～10 ng/ml时行前列腺穿刺活检术的研究报道,共纳入20篇文献、5481例患者.提取数据后用R软件进行荟萃分析,用随机效应模型计算率值,I2检验分析异质性,用漏斗图评估偏倚.对阳性结果的Gleason评分进行分析,并比较该研究和《2014版中国泌尿外科疾病诊断治疗》(《指南》)数据的差异性.结果 荟萃分析表明,t-PSA为4～10 ng/ml时前列腺穿刺阳性率为20.6％,高于《指南》给出的15.9％,差异有显著性意义.《指南》数据的循证医学证据水平为Ⅲ级,该荟萃研究的循证医学证据水平为Ⅰa级.结论 t-PSA在4～10 ng/ml时,无论游离-PSA(f-PSA)/t-PSA比值大小,前列腺穿刺活检均具有较高的诊断效能.灰区前列腺癌Gleason评分较低,危险因素等级较低.%Objective To investigate the diagnostic efficiency and result of prostate biopsy for patients with t -PSA between 4.0 and 10 ng/ml.Methods This analysis was based on 20 qualified research papers from such lectronic databases as PubMed, MEDLINE, EMBASE and Cochrane from January 2010 until September 2017.Data extracted was analyzed using classic Meta-analysis with R software .The random or fixed effect model analysis was used to estimate the rate.Heterogeneity was analyzed using I 2 statistic.Results Totally 5481 patients were included in the 20 research papers. The positive rate of prostate biopsy was 20.6％, with t-PSA between 4.0 and 10 ng/ml, which was higher than the rate in the data from CUA Guide(2014).The difference was statistically significant .Conclusion Patients should be subjected to prostate biopsy if their t-PSA ranges 4.0 from 10 ng/ml regardless of the rate of f/t-PSA.The Gleason grade is relatively low when PSA is in the gray area , and the risk is also low.