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目的:研究前列腺按摩后尿液中PCA3mRNA及PCA3mRNA密度的定量检测在前列腺特异性抗原(PSA)灰区前列腺癌(PCa)临床诊断中的应用价值。方法:选择sPSA在4~10ng/ml的BPH或PCa患者200例,收集其前列腺按摩后尿液,离心取细胞沉淀物,提取总RNA,用实时荧光定量RT-PCR方法检测PSAmRNA、PCA3mRNA的含量,以PSAmRNA来校正尿液中的前列腺癌细胞。以PCA3mRNA/PSAmRNA表示PCA3mRNA的含量,经直肠B超测定前列腺体积,计算PSAD和PCA3mRNA密度(PCA3mRNA/D)。以穿刺活检或术后病理检查结果为金标准,用ROC曲线对PCA3mRNA及PCA3mRNA/D诊断PSA灰区PCa的性能进行评价。结果:PCa组的tPSA、PSAD均较BPH组升高(P<0.05或0.01)。PCa组PCA3mRNA(P=0.009)含量及PCA3mRNA/D比值(P=0.005)均高于BPH组;以2.01为截断值时,尿PCA3mRNA/D比值诊断PCa的ROC曲线下面积(AUC)为0.903(95%CI:0.790~0.869),其诊断PCa的敏感度和特异度分别为93.3%和66.7%。尿PCA3mRNA/PSAmRNA比值诊断PCa的ROC曲线下面积(AUC)为0.841(95%CI:0.666~0.997),以0.27为截断值时,其诊断PCa的敏感度和特异度为86.5%和77.5%。结论:PCA3mRNA含量和PCA3mRNA/D两个指标定量检测,可以显著提高检出PSA灰区PCa的敏感度,可用于早期PCa的诊断。其中PCA3mRNA/D具有更好的诊断效能。
Objective: To study the value of quantitative detection of PCA3 mRNA and PCA3 mRNA in prostate after prostate massage in the clinical diagnosis of prostate-specific antigen (PSA) gray zone prostate cancer (PCa). Methods: 200 BPH or PCa patients with sPSA at 4 ~ 10ng / ml were selected to collect the urine after prostate massage. The cell pellet was centrifuged and the total RNA was extracted. The contents of PSA mRNA and PCA3 mRNA were detected by real-time fluorescence quantitative RT-PCR PSA mRNA was used to correct prostate cancer cells in the urine. PCA3 mRNA was expressed as PCA3 mRNA / PSA mRNA, prostate volume was measured by rectal B ultrasound, and PSAD and PCA3 mRNA density (PCA3 mRNA / D) were calculated. Using puncture biopsy or postoperative pathological examination as the gold standard, PCA3 mRNA and PCA3 mRNA / D were used to evaluate the performance of PCa in PCa with PCNA by ROC curve. Results: The levels of tPSA and PSAD in PCa group were significantly higher than those in BPH group (P <0.05 or 0.01). The PCA3 mRNA and PCA3 mRNA / D ratios in PCa group were higher than those in BPH group (P = 0.005). The area under the ROC curve of PCa with PCA3 mRNA / D ratio of 2.01 was 0.903 95% CI: 0.790-0.869). The sensitivity and specificity of diagnosing PCa were 93.3% and 66.7% respectively. The area under the ROC curve (AUC) of urinary PCA3mRNA / PSA mRNA ratio in diagnosis of PCa was 0.841 (95% CI: 0.666-0.997). The diagnostic sensitivity and specificity of PCa for PCa at the cutoff value of 0.27 were 86.5% and 77.5%, respectively. Conclusion: The quantitative detection of PCA3 mRNA and PCA3 mRNA / D can significantly improve the sensitivity of detection of PCa in PSA gray zone, which can be used in the diagnosis of early PCa. Which PCA3 mRNA / D has a better diagnostic performance.