CAJ | 학술논문

目的探讨外周血、尿液中PCA3和PSA基因表达在前列腺癌诊断中的应用价值.方法 2009年6月至12月因前列腺疾病住院患者105例,收集前列腺按摩后的初始尿液和外周血标本,经病理证实前列腺癌37例、BPH 68例；8例泌尿系结石患者作为正常对照.应用实时定量PCR检测尿沉渣、外周血单个核细胞中PCA3、PSA mRNA表达,以β-actin为内参照. 结果外周血PCA3的mRNA表达敏感性为48.6％,特异性为100％.尿PCA3评分经ROC曲线分析,ROC- AUC=0.908,以截断值64.6为诊断前列腺癌的临界值,前列腺癌患者中尿PCA3阳性率为81.1％,BPH患者中尿PCA3阴性率为86.8％.5例血清tPSA＜4μg/L前列腺癌患者,尿PCA3评分诊断前列腺癌4例；3例血清tPSA 4 ～ 10 μg/L前列腺癌患者,尿PCA3评分诊断前列腺癌2例；29例血清tPSA＞10.μg/L前列腺癌患者,尿PCA3评分诊断前列腺癌24例(82.8％).22例血清tPSA＜4μg/L BPH者,PCA3评分诊断阴性率为89.4％ (20/22)；19例血清tPSA 4 ～ 10 μg/L BPH者中,PCA3评分诊断阴性率为84.2％ (16/19)；27例血清tPSA＞ 10 μg/L BPH者中,PCA3评分诊断阴性率为81.5％ (22/27).尿PCA3评分、外周血PCA3联合检测的敏感性为86.5％,高于两者单独测定. 结论外周血中的PCA3 mRNA表达是诊断前列腺癌的特异性指标,尿PCA3评分联合检测外周血中PCA3基因表达可以提高前列腺癌的诊断敏感性.
목적 탐토외주혈、뇨액중PCA3화PSA기인표체재전렬선암진단중적응용개치.방법 2009년6월지12월인전렬선질병주원환자105례,수집전렬선안마후적초시뇨액화외주혈표본,경병리증실전렬선암37례、BPH 68례；8례비뇨계결석환자작위정상대조.응용실시정량PCR검측뇨침사、외주혈단개핵세포중PCA3、PSA mRNA표체,이β-actin위내삼조. 결과 외주혈PCA3적mRNA표체민감성위48.6％,특이성위100％.뇨PCA3평분경ROC곡선분석,ROC- AUC=0.908,이절단치64.6위진단전렬선암적림계치,전렬선암환자중뇨PCA3양성솔위81.1％,BPH환자중뇨PCA3음성솔위86.8％.5례혈청tPSA＜4μg/L전렬선암환자,뇨PCA3평분진단전렬선암4례；3례혈청tPSA 4 ～ 10 μg/L전렬선암환자,뇨PCA3평분진단전렬선암2례；29례혈청tPSA＞10.μg/L전렬선암환자,뇨PCA3평분진단전렬선암24례(82.8％).22례혈청tPSA＜4μg/L BPH자,PCA3평분진단음성솔위89.4％ (20/22)；19례혈청tPSA 4 ～ 10 μg/L BPH자중,PCA3평분진단음성솔위84.2％ (16/19)；27례혈청tPSA＞ 10 μg/L BPH자중,PCA3평분진단음성솔위81.5％ (22/27).뇨PCA3평분、외주혈PCA3연합검측적민감성위86.5％,고우량자단독측정. 결론 외주혈중적PCA3 mRNA표체시진단전렬선암적특이성지표,뇨PCA3평분연합검측외주혈중PCA3기인표체가이제고전렬선암적진단민감성.
Objective To detect the gene expression of PCA3 and PSA in peripheral blood and urine simultaneously to investigate whether PCA3 combining PSA gene could become new markers for diagnosis of Pca. Methods From June 2009 to December 2009,the initial urine after prostatic massage and the peripheral blood specimens were collected from 37 patients with PCa and 68 patients with BPH that were pathologically confirmed,g patients with urinary stone were used as normal control,the expression of PCA3 and PSA mRNA of mononuclear cells in urine sediments and peripheral blood were detected by fluorescence real-time quantitative PCR,with β-actin mRNA as internal control. Results The sensitivity and specificity of the expression of PCA3 mRNA in peripheral blood for diagnosis of prostate cancer were 48.6％ and 100％ respectively.ROC curve analysis was performed for the PCA3 score and the area under the ROC curve was 0.908.Using 64.6 as the cutoff,the sensitivity was 81.1％ and the specificity was 86.8％.In group with serum tPSA value ＜4 pg/L,the positive rate and negative rate of urinary PCA3 score for diagnosing prostate cancer were 80％ (4/5) and 89.4％ (20/22) respectively.In group with serum tPSA value 4 - 10 μg/L,the positive rate and negative rate of urinary PCA3 score were 66.7％ ( 2/3 ) and 84.2％(16/19) respectively.In group with serum tPSA value ＞ 10 μg/L,the positive rate and negative rate of urinary PCA3 score were 82.8％ (24/27) and 81.5％ (22/27) respectively.The sensitivity of simultaneous detection of PCA3 mRNA in peripheral blood and urinary PCA3 score was 86.5％. Conclusions The expression of PCA3 mRNA in peripheral blood was a specific marker for the diagnosis of PCa.The simultaneous detection of PCA3 mRNA in peripheral blood and urinary PCA3 score could increase the sensitivity for the diagnosis of PCa.