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目的探讨前列腺被膜支血管阻力指数(RI)与前列腺癌(PCa)的关系。方法利用彩色多普勒超声检测87例前列腺穿刺活检患者的前列腺被膜支血管RI,并行前列腺穿刺组织活检。分析前列腺被膜支血管RI在PCa中的诊断价值,并与血清总前列腺特异性抗原(tPSA)、游离/总前列腺特异性抗原(f/tPSA)及前列腺特异性抗原密度(PSAD)的诊断价值比较。运用受试者工作特性(ROC)曲线,确定前列腺被膜支血管RI最佳临界点。结果 87例前列腺穿刺活检患者中,良性前列腺增生(BPH)56例(64.4%),PCa 31例(35.6%)。与BPH相比,PCa的前列腺被膜支血管RI明显升高(0.72±0.10vs.0.78±0.10)P<0.05)。tPSA、f/tPSA、PSAD在PCa和BPH患者之间均有统计学差异(P<0.05)。但在灰区(tPSA为4-10ng/ml)患者中,仅前列腺被膜支血管RI和PSAD存在统计学差异(P<0.05)。ROC曲线确定前列腺被膜支血管RI诊断PCa最佳临界点为0.72,当RI≥0.72系列联合PSAD>0.15ng.ml-1.cm-3时,诊断PCa的敏感度77.4%、特异度78.6%。结论测定前列腺被膜支血管RI对鉴别PCa与BPH有着重要临床应用价值,尤其当tPSA处于灰区时。前列腺被膜支血管RI联合PSAD在诊断PCa时有较好的敏感度和特异度。
Objective To investigate the relationship between prostatic tunica collateral vessel resistance index (RI) and prostate cancer (PCa). Methods 87 cases of prostate biopsy were examined by color Doppler ultrasonography of prostatic tunica intima and biopsy of prostate. The diagnostic value of prostatic tunica collateral vessels RI in PCa was analyzed and compared with the diagnostic value of serum total prostate specific antigen (tPSA), free / total prostate specific antigen (f / tPSA) and prostate specific antigen density (PSAD) . The receiver operating characteristic (ROC) curve was used to determine the optimal critical point of the capillaries of the prostate capillaries. Results Of the 87 prostate biopsy patients, 56 (64.4%) had benign prostatic hyperplasia (BPH) and 31 (35.6%) had PCa. Compared with BPH, PCa had significantly higher RI of prostatic capsule (P <0.05) (0.72 ± 0.10 vs.0.78 ± 0.10). The levels of tPSA, f / tPSA and PSAD in PCa and BPH patients were significantly different (P <0.05). However, in the gray area (tPSA of 4-10ng / ml), only the presence of a significant difference in the RI and PSAD of the tunica capillaries (P <0.05). The best cutoff point of ROC curve was 0.72 for diagnosis of PCa by the ROC curve. The sensitivity and specificity of PCa were 77.4% and 78.6% respectively when RI≥0.72 series combined with PSAD> 0.15ng.ml-1.cm-3. Conclusion The determination of prostatic tunica collateral vessels RI has important clinical value in differentiating PCa from BPH, especially when tPSA is in the gray zone. Prostate capillaries RI combined with PSAD in the diagnosis of PCa has a good sensitivity and specificity.