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目的:探讨危险评分系统在提高前列腺重复活检阳性率方面的临床应用价值。方法:选择1999～2010年期间接受前列腺重复穿刺活检的129例患者作为本次研究对象,分别对其体质指数(BMI)、直肠指诊(DRE)、总前列腺特异抗原(tPSA)、游离前列腺特异抗原(fPSA)、游离与总前列腺特异抗原比值(f/tPSA)、前列腺体积(PV)、前列腺特异抗原密度(PSAD)、前列腺特异抗原速率(PSAV)、前列腺特异抗原倍增时间(PSADT)、前列腺体积与活检针数比率(VBR)等重复活检结果的潜在预测指标进行单变量分析和多元逐步罗吉斯逻辑回归分析并构建一套评分系统。结果:129例患者的重复活检结果显示BPH95例,前列腺癌(PCa)34例,前列腺重复活检阳性率为26.36%。分析结果证实DRE、tPSA、f/tPSA以及VBR等指标可作为重复活检结果的重要独立预测指标。参考相关独立预测指标而构建的评分系统显示:相比“危险评分”为0～2分的患者,3～5分的患者经重复活检前列腺癌的检出率更高(分别有10.13%和52.00%,P<0.001)。结论:通过研究发现的确存在预测前列腺重复活检结果的关键指标。利用预测指标构建一套评分系统,能够在实际工作中帮助临床医师判断究竟哪些患者更适合行前列腺重复穿刺活检术。
Objective: To investigate the clinical value of risk scoring system in improving the positive rate of prostate biopsy. Methods: A total of 129 patients who underwent repeat prostatic biopsy from 1999 to 2010 were selected as the study subjects. Their body mass index (BMI), digital rectal examination (DRE), total prostate specific antigen (tPSA), free prostate specific antigen (F / tPSA), prostate volume (PV), PSAD, PSAV, PSADT, prostate, Volume and the number of biopsies (VBR) and other potential biopsy results predict univariate analysis and multiple stepwise Logistic regression analysis and build a scoring system. Results: The repeat biopsy results of 129 patients showed that there were 95 cases of BPH and 34 cases of prostate cancer (PCa). The positive rate of prostate biopsy was 26.36%. The results confirmed that DRE, tPSA, f / tPSA and VBR and other indicators can be used as independent repeat biopsy outcome independent predictors. Scoring systems constructed with reference to independent predictors showed a higher detection rate of prostate cancer with repeat biopsies of 3 to 5 points (10.13%, respectively) compared with patients with a risk score of 0 to 2 And 52.00%, P <0.001). CONCLUSIONS: The key indicators that predict the outcome of prostate biopsies do exist through research. The use of predictive indicators to build a scoring system can help clinicians in actual work to determine which patients are more suitable for prostate puncture biopsy.