剪切波弹性成像对前列腺增生病理类型诊断的初步研究
发布时间：2019-02-24 16:49
【摘要】：目的：通过经直肠剪切波弹性超声成像检测BPH患者前列腺移行区的弹性模量,分析弹性模量与前列腺增生病理类型的相关性,判断前列腺增生的病理类型,为临床药物治疗BPH提供参数指导,同时试图寻找前列腺移行区弹性模量、病理类型与临床参数之间的关系,为前列腺增生的诊疗提供新的理论依据。 方法：收集2013年7月到2014年1月在中南大学湘雅医学院附属海口医院泌尿外科行经尿道前列腺电切术BPH患者前列腺标本共37例。记录患者IPSS评分、tPSA、fPSA。对37例患者行TURS及经直肠剪切波弹性成像检查,测量前列腺体积以及前列腺移行区弹性模量平均值。HE染色结合Image-pro plus6.0软件观察分析判断BPH增生病理类型。相关数据用SPSS19.0统计软件分析。计量资料两组间均数的比较用t检验。通过弹性模量值绘制ROC曲线,根据约登指数来确定判断前列腺增生病理类型的弹性模量值的最佳截断点。变量间的相关性检验Pearson相关系数表示。P0.05为差异有统计学意义。 结果： 1.HE染色结果：腺体增生为主的BPH12例,间质增生为主BPH25例； 2.间质增生为主的BPH组与腺体增生为主的BPH组的弹性模量差异比较具有统计学,间质增生为主的BPH组的弹性模量(34.93±8.318)KPa明显高于腺体增生为主的BPH组(24.54±3.816) KPa。(F=3.821,P=0.059, t=-4.100,P0.001). 3.根据ROC曲线统计分析,弹性模量值的最佳截断点为27.45KPa, AUC=0.935,约登指数为0.753,灵敏度为92.0%,特异度为83.3%,准确度为89.2%； 4.间质增生为主的BPH组的与腺体增生为主的BPH组的tPSA、fPSA、IPSS、体积统计比较分析中均有统计学意义,间质增生为主的BPH组的tPSA浓度(2.15±0.769)ng/ml、fPSA浓度(0.54±0.292) ng/ml、体积(41.25±15.233)cm3低于腺体增生为主的BPH组tPSA浓度(4.93±2.673)ng/ml、fPSA浓度(1.12±0.529)ng/ml、体积(69.05±13.173)cm3。间质增生为主的BPH组IPSS评分(27.00±3.136)分高于BPH组(22.92±2.466)分。 5.弹性模量与IPSS(r=0.468,p=0.004)为正相关、与tPSA(r=-0.346,p=0.036).fPSA(r=-0.421,p=0.009)、体积(r=-0.732,p0.001)为负相关。 结论： 1.剪切波弹性成像技术对判断前列腺增生的病理类型具有一定的诊断价值。本研究弹性模量最佳诊断截点为27.45KPa。 2.不同病理类型的BPH其临床特点不同。间质增生为主的BPH患者的临床特点为：弹性模量值较高、体积偏小、PSA水平较低、症状较重。腺体增生为主的BPH患者的临床特点与之相反。
[Abstract]:Objective: to detect the modulus of elasticity in the transitional zone of prostate in patients with BPH by transrectal shear wave elastography, and to analyze the correlation between the modulus of elasticity and the pathological type of benign prostatic hyperplasia (BPH), and to judge the pathological type of BPH. It provides parameter guidance for clinical drug therapy of BPH, and tries to find out the relationship among the elastic modulus, pathological type and clinical parameters in the transitional zone of prostate, thus providing a new theoretical basis for the diagnosis and treatment of prostatic hyperplasia. Methods: from July 2013 to January 2014, 37 prostate specimens were collected from patients undergoing transurethral resection of the prostate (BPH) in the Department of Urology, affiliated Haikou Hospital, Xiangya Medical College, Central South University. Record patient IPSS score, tPSA,fPSA. TURS and transrectal shear wave elastography were performed in 37 patients. The volume of prostate and the mean elastic modulus of the transitional area of prostate were measured. The pathological types of BPH hyperplasia were determined by HE staining and Image-pro plus6.0 software. The related data were analyzed by SPSS19.0 statistical software. T test was used to compare the mean between the two groups. The ROC curve was drawn by the elastic modulus value and the best cut-off point for judging the elastic modulus value of the pathological type of benign prostatic hyperplasia was determined according to the Jorden index. The correlation test between variables Pearson correlation coefficient expression. P0.05 for the difference was statistically significant. Results: the results of 1.HE staining were as follows: BPH12 with glandular hyperplasia, BPH25 with interstitial hyperplasia and 2. The difference of elastic modulus between BPH group and BPH group was statistically significant. The elastic modulus of BPH group (34.93 卤8.318) KPa was significantly higher than that of BPH group (24.54 卤3.816) KPa. (FN 3.821 P0. 059, t0. 100% P0. 001). 3. According to the statistical analysis of ROC curve, the best cut-off point of elastic modulus value is 27.45 KPA, the AUC=0.935, Yorden index is 0.753, the sensitivity is 92.0, the specificity is 83.3, the accuracy is 89.2KPA; There was significant difference in the volume of tPSA,fPSA,IPSS, between BPH group and BPH group. The tPSA concentration of BPH group with interstitial hyperplasia was (2.15 卤0.769) ng/ml,. FPSA concentration (0.54 卤0.292) ng/ml, volume (41.25 卤15.233) cm3 was lower than that in glandular hyperplasia BPH group (4.93 卤2.673) ng/ml,fPSA concentration (1.12 卤0.529) ng/ml, volume (69.05 卤13.173) cm3.. The IPSS score of BPH group (27.00 卤3.136) was higher than that of BPH group (22.92 卤2.466). 5. The elastic modulus was positively correlated with IPSS (r = 0.468) and negatively correlated with tPSA (r ~ (-0.344). FPSA (~ (0.036). FPSA (~ (-0.421). FPSA (~ (0.009) and volume (r ~ (-0.732) / p ~ (0.001). Conclusion: 1. Shear wave elastography is valuable in the diagnosis of benign prostatic hyperplasia (BPH). The best diagnostic cut-off point of elastic modulus in this study is 27.45 KPA. 2. Different pathological types of BPH have different clinical characteristics. The clinical features of BPH patients with interstitial hyperplasia were high elastic modulus, small volume, low PSA level and severe symptoms. The clinical characteristics of BPH patients with glandular hyperplasia were opposite.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R697.3
本文编号：2429738
[Abstract]:Objective: to detect the modulus of elasticity in the transitional zone of prostate in patients with BPH by transrectal shear wave elastography, and to analyze the correlation between the modulus of elasticity and the pathological type of benign prostatic hyperplasia (BPH), and to judge the pathological type of BPH. It provides parameter guidance for clinical drug therapy of BPH, and tries to find out the relationship among the elastic modulus, pathological type and clinical parameters in the transitional zone of prostate, thus providing a new theoretical basis for the diagnosis and treatment of prostatic hyperplasia. Methods: from July 2013 to January 2014, 37 prostate specimens were collected from patients undergoing transurethral resection of the prostate (BPH) in the Department of Urology, affiliated Haikou Hospital, Xiangya Medical College, Central South University. Record patient IPSS score, tPSA,fPSA. TURS and transrectal shear wave elastography were performed in 37 patients. The volume of prostate and the mean elastic modulus of the transitional area of prostate were measured. The pathological types of BPH hyperplasia were determined by HE staining and Image-pro plus6.0 software. The related data were analyzed by SPSS19.0 statistical software. T test was used to compare the mean between the two groups. The ROC curve was drawn by the elastic modulus value and the best cut-off point for judging the elastic modulus value of the pathological type of benign prostatic hyperplasia was determined according to the Jorden index. The correlation test between variables Pearson correlation coefficient expression. P0.05 for the difference was statistically significant. Results: the results of 1.HE staining were as follows: BPH12 with glandular hyperplasia, BPH25 with interstitial hyperplasia and 2. The difference of elastic modulus between BPH group and BPH group was statistically significant. The elastic modulus of BPH group (34.93 卤8.318) KPa was significantly higher than that of BPH group (24.54 卤3.816) KPa. (FN 3.821 P0. 059, t0. 100% P0. 001). 3. According to the statistical analysis of ROC curve, the best cut-off point of elastic modulus value is 27.45 KPA, the AUC=0.935, Yorden index is 0.753, the sensitivity is 92.0, the specificity is 83.3, the accuracy is 89.2KPA; There was significant difference in the volume of tPSA,fPSA,IPSS, between BPH group and BPH group. The tPSA concentration of BPH group with interstitial hyperplasia was (2.15 卤0.769) ng/ml,. FPSA concentration (0.54 卤0.292) ng/ml, volume (41.25 卤15.233) cm3 was lower than that in glandular hyperplasia BPH group (4.93 卤2.673) ng/ml,fPSA concentration (1.12 卤0.529) ng/ml, volume (69.05 卤13.173) cm3.. The IPSS score of BPH group (27.00 卤3.136) was higher than that of BPH group (22.92 卤2.466). 5. The elastic modulus was positively correlated with IPSS (r = 0.468) and negatively correlated with tPSA (r ~ (-0.344). FPSA (~ (0.036). FPSA (~ (-0.421). FPSA (~ (0.009) and volume (r ~ (-0.732) / p ~ (0.001). Conclusion: 1. Shear wave elastography is valuable in the diagnosis of benign prostatic hyperplasia (BPH). The best diagnostic cut-off point of elastic modulus in this study is 27.45 KPA. 2. Different pathological types of BPH have different clinical characteristics. The clinical features of BPH patients with interstitial hyperplasia were high elastic modulus, small volume, low PSA level and severe symptoms. The clinical characteristics of BPH patients with glandular hyperplasia were opposite.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R697.3
【参考文献】
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1 张倩倩;王学梅;李银燕;耿晶;张义侠;李响;康姝;;剪切波弹性成像在乳腺良恶性病变鉴别诊断中的价值[J];中国临床医学影像杂志;2012年06期
，本文编号：2429738
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