CAJ | 학술논문

目的：探讨前列腺特异性抗原密度（PSAD）检测对前列腺特异抗原（PSA）灰区前列腺良恶性疾病的鉴别诊断价值。方法回顾该院2008年4月至2012年11月收治的疑似前列腺癌的患者56例，其PSA值均在4～10ng/mL。经直肠超声测定前列腺体积，化学发光法测血清PSA水平，经前列腺穿刺活检或术后组织病理检查证实前列腺癌患者21例（前列腺癌组），前列腺增生患者35例（前列腺增生组）。比较前列腺癌患者与前列腺增生患者组间腺体体积以及PSAD值的差异。结果前列腺癌组与前列腺增生组比较，血清tPSA差异无统计学意义，前列腺体积及PSAD值差异有统计学意义。以前列腺癌患者前列腺体积的平均值39．27为参考值，设前列腺体积40mL为临界点，则80．95％的前列腺癌患者的腺体体积小于40mL，68．57％的患者腺体体积大于40mL，组间比较差异有统计学意义。以前列腺增生患者的平均PSAD值0．147为参考值，设PSAD值0．15为临界值，则其对前列腺体积小于40mL的患者判定前列腺癌的敏感性为80．95％，特异性为72．73％，阳性预测值为85％，阴性预测值为61．54％；前列腺体积大于40mL的患者，其判定前列腺癌的敏感性为75％，特异性为66．67％，阳性预测值为27．27％，阴性预测值为94．11％。结论PSAD值对处于PSA灰区的前列腺癌有一定的鉴别诊断价值，若以0．15为PSAD的临界值，则随着前列腺体积的增大其鉴别前列腺癌的敏感性和特异性均有所降低，其影响因素尚待进一步的深入研究。
목적：탐토전렬선특이성항원밀도（PSAD）검측대전렬선특이항원（PSA）회구전렬선량악성질병적감별진단개치。방법회고해원2008년4월지2012년11월수치적의사전렬선암적환자56례，기PSA치균재4～10ng/mL。경직장초성측정전렬선체적，화학발광법측혈청PSA수평，경전렬선천자활검혹술후조직병리검사증실전렬선암환자21례（전렬선암조），전렬선증생환자35례（전렬선증생조）。비교전렬선암환자여전렬선증생환자조간선체체적이급PSAD치적차이。결과전렬선암조여전렬선증생조비교，혈청tPSA차이무통계학의의，전렬선체적급PSAD치차이유통계학의의。이전렬선암환자전렬선체적적평균치39．27위삼고치，설전렬선체적40mL위림계점，칙80．95％적전렬선암환자적선체체적소우40mL，68．57％적환자선체체적대우40mL，조간비교차이유통계학의의。이전렬선증생환자적평균PSAD치0．147위삼고치，설PSAD치0．15위림계치，칙기대전렬선체적소우40mL적환자판정전렬선암적민감성위80．95％，특이성위72．73％，양성예측치위85％，음성예측치위61．54％；전렬선체적대우40mL적환자，기판정전렬선암적민감성위75％，특이성위66．67％，양성예측치위27．27％，음성예측치위94．11％。결론PSAD치대처우PSA회구적전렬선암유일정적감별진단개치，약이0．15위PSAD적림계치，칙수착전렬선체적적증대기감별전렬선암적민감성화특이성균유소강저，기영향인소상대진일보적심입연구。
Objective To investigate the clinical significance of prostate specific antigen density (PSAD)value in the differential diagnosis from malignant and benign prostate disease .Methods 56 patients who enrolled in this hospital during April 2008 to No-vember 2012 were reviewed ,all of them were suspected as prostate carcinoma with free total PSA value at 4-10 ng/mL .Prostate volume were determined via transrectal ultrasound ,while serum PSA was determined by chemiluminescence method ,and all patients were finally pathologically diagnosed via tissue biopsy or prostatectomy .21 cases were proved to be prostate carcinoma (prostate carcinoma group) ,and the other 35 cases were proved to be benign prostate hyperplasia(BPH) .And the statistical significances of tPSA ,prostate volume and PSAD values were compared between the two groups .Results Compared with BPH group ,serum level of tPSA was insignificant ,while the values of prostate volume and PSAD were significantly lower in the BPH group than in prostate carciboma group .Considering the mean prostate volume(39 .27 mL) as the reference point ,40 mL was set as the cut-off value of prostate volume .Therefore ,there were 80 .95% prostate carcinoma group patients whose prostate volume were less than 40 mL , and 68 .57% benign prostate hyperplasia group patients whose prostate volume were larger than 40 mL .Considering the PSAD val-ue(0 .147) as the reference point ,0 .15 was set as the cut-off value of PSAD .Therefore ,the sensitivity ,specificity ,positive predic-tive value and negative predictive value among patients with prostate volume less than 40 mL ,the datas were respectively as 80 .95% ,72 .73% ,85% and 61 .54% .While ,among patients with prostate volume larger than 40 mL ,were respectively as 75% , 66 .67% ,27 .27% and 94 .11% .Conclusion PSAD was of certain value in the differential diagnosis of prostate carcinoma in PSA gray zone cases .If PSAD=0 .15 was consider as the cut-off point ,the sensitivity and specificity of differential diagnosis for prostate carcinoma decreased as the prostate volume increase .However ,the influencing factors are still to be elucidated .