RDW和前列腺干细胞抗原SNP对前列腺穿刺活检阳性率的影响

发布时间：2018-05-19 21:30

本文选题：红细胞分布宽度 + 前列腺肿瘤　；参考：《苏州大学》2016年硕士论文

【摘要】：前列腺癌(PCa)是发生于男性中的一种常见恶性肿瘤,好发于老年男性且发病隐匿,严重威胁着老年男性的身体健康。目前PCa的发病危险因素尚未明确,临床上用于诊断PCa的基本方法有前列腺特异性抗原(PSA)检查、直肠指检和经直肠超声检查,而经直肠超声检查引导下的前列腺穿刺活检是PCa的诊断金标准。随着前列腺恶性肿瘤疾病筛查的普及,前列腺穿刺活检患者的数量越来越多,然而我国前列腺穿刺活检阳性率相对较低,导致了一些患者不必要的前列腺穿刺活检。因此,研究影响前列腺穿刺活检结果的相关指标,明确前列腺穿刺活检阳性的相关因素,提高前列腺穿刺活检阳性率具有极大的科研及临床意义。本研究分两个部分:第一部分我们分析了前列腺穿刺活检患者的红细胞分布宽度(RDW),比较穿刺阳性和穿刺阴性患者RDW的差异,探讨在前列腺穿刺活检患者中测定RDW的临床意义;第二部分,我们测定了前列腺穿刺活患者的前列腺干细胞抗原(PSCA)rs1045531多态性,初步研究了PSCA单核苷酸多态性(SNP)在前列腺穿刺活检患者中的临床意义。第一部分前列腺穿刺活检患者中红细胞分布宽度测定的临床意义目的:探讨红细胞分布宽度(RDW)在前列腺穿刺活检患者中的临床意义。方法:分析比较前列腺穿刺活检患者穿刺病理结果为前列腺癌(PCa)和良性前列腺增生(BPH)患者间RDW、前列腺特异性抗原(PSA)、血红蛋白(HB)、血白细胞(WBC)、血小板(PLT)、甘油三酯(TG)和年龄的差异,Logistic回归分析RDW、PSA、HB和年龄对前列腺穿刺阳性的影响。运用受试者工作特性(ROC)曲线分析比较RDW在不同PSA时对前列腺穿刺阳性的影响。运用方差分析和Spearman等级相关分析来分析比较RDW与PCa患者PSA、Gleason评分及临床分期的关系。依据2002 AJCC TNM classification将早期PCa(≤T2N0M0)患者筛选出,剔除中晚期PCa患者,重新对RDW与穿刺阳性关系进行统计学分析,本研究中早期PCa特指临床局限性PCa。结果:PCa患者RDW[(13.38±1.11)%,359例]高于BPH患者[(12.75±0.62)%,434例],差异有统计学显著意义(P0.001),RDW是前列腺穿刺阳性的独立影响因素,明显优于年龄和PSA(OR值分别为2.440、1.061和1.017)。PSA20ng/ml组患者ROC曲线下面积(AUCRDW)明显高于PSA10ng/ml组和PSA(10~20ng/ml)组,三组的AUCRDW分别为0.730(P0.05)、0.560(P0.05)和0.639(P0.05)。PCa患者不同PSA组、Gleason评分组及临床分期之间的RDW差异分别都具有统计学意义(P0.05),并且随着疾病危险度越高,RDW值越大。并进一步行RDW与早期PCa的Logistic回归分析,结果显示RDW作为早期PCa的独立影响因素,OR值达到最高的2.547(P0.001)。结论:1、RDW在PCa患者中高于BPH患者,RDW是前列腺穿刺阳性的独立影响因子。2、RDW可用于预测前列腺穿刺阳性,尤其是PSA20ng/ml的穿刺患者。3、RDW分别与PSA、Gleason评分及临床分期都呈正相关,可用于评估PCa危险程度。4、RDW判断早期PCa时OR值最高,对临床上PCa的早发现具有重要意义。第二部分前列腺穿刺活检患者中前列腺干细胞抗原SNP的初步研究目的:研究前列腺穿刺活检患者中前列腺干细胞抗原(PSCA)基因单核苷酸多态性(SNP)与前列腺癌(PCa)的相关性。方法:分析研究前列腺穿刺活检患者的PSCA rs1045531的多态性,比较PCa和良性前列腺增生(BPH)患者间rs1045531基因型分布频率的差异,并分析该基因多态性与穿刺患者年龄、前列腺特异性抗原(PSA)和Gleason评分的相关性。结果:PCa组(67例)与BPH组(77例)患者的PSCA rs1045531基因型分布频率差异具有统计学意义(P=0.036)。与CC型基因相比,AC型基因显著增加PCa的患病风险(OR=2.383,95%CI=1.198-4.741,P=0.013)。进一步分析rs1045531基因多态性与穿刺患者年龄、PSA和Gleason评分的关系,分析结果显示在所有前列腺穿刺活检患者中rs1045531 AC型患者PSA(53.49±29.24ng/ml)明显高于CC型(22.42±18.74ng/ml)(P=0.019);在PCa患者中AC型患者PSA(69.89±53.00ng/ml)也明显高于CC型的PSA(24.40±11.73ng/ml)(P=0.025)。结论:PSCA rs1045531 AC型基因与PCa的发病风险相关,且与前列腺穿刺活检患者的PSA相关,可用于PCa的发病预测和预后评估。
[Abstract]:Prostate cancer (PCa) is a common malignant tumor occurring in men. It occurs in old men and is concealed. It is a serious threat to the health of old men. The risk factors of PCa are not clear. The basic methods used for diagnosis of PCa are prostate specific antigen (PSA), rectal examination and transrectal ultrasound The prostate biopsy guided by rectal ultrasound is the diagnostic gold standard for PCa. With the prevalence of prostate cancer screening, the number of patients with prostate biopsy is increasing, but the positive rate of prostate biopsy in our country is relatively low, leading to unnecessary prostate biopsy in some patients. Therefore, it is of great scientific and clinical significance to study the related factors affecting the results of prostate biopsy, to clarify the related factors of positive prostate biopsy and to improve the positive rate of prostate biopsy. This study is divided into two parts: in the first part, we analyzed the red cell distribution width (RDW) of the prostate biopsy patients, and compared the results. The difference in RDW between positive puncture and puncture negative patients was discussed. The clinical significance of measuring RDW in prostate biopsy patients was discussed. The second part, we measured the prostate stem cell antigen (PSCA) rs1045531 polymorphism of prostate biopsy patients, and preliminarily studied the presence of PSCA monoside polymorphism (SNP) in prostate biopsy patients. Clinical significance of the measurement of red cell distribution width in the first part of the prostate biopsy: the clinical significance of the red cell distribution width (RDW) in the patients with prostate biopsy. Methods: analysis and comparison of the pathological results of prostate biopsy patients for prostate cancer (PCa) and benign prostatic hyperplasia (BPH) RDW, prostate specific antigen (PSA), hemoglobin (HB), blood leukocyte (WBC), platelets (PLT), triglyceride (TG) and age differences. Logistic regression analysis of the effects of RDW, PSA, HB and age on prostatic puncture positive effects. The effects of RDW on prostate biopsy positive effects were compared with the subjects' working characteristics (ROC) curve. The relationship between RDW and PCa patients' PSA, Gleason score and clinical staging was analyzed by variance analysis and Spearman grade correlation analysis. According to 2002 AJCC TNM classification, the early PCa (< < < < T2N0M0) patients were screened out and the middle and late PCa patients were eliminated, and the relationship between RDW and puncture positive was statistically analyzed. The results of clinical limited PCa.: RDW[(13.38 + 1.11)% of PCa patients, 359 Cases, higher than BPH patients [(12.75 + 0.62)%, 434], the difference was statistically significant (P0.001), RDW was an independent influence factor of prostate biopsy positive, obviously superior to age and PSA (OR value respectively 2.440,1.061 and 1.017).PSA20ng/ml group under ROC curve area (AUCRDW) Ming Compared with group PSA10ng/ml and PSA (10~20ng/ml), AUCRDW in three groups was 0.730 (P0.05), 0.560 (P0.05) and 0.639 (P0.05).PCa were in different PSA groups. The RDW difference between the Gleason score group and the clinical stage was statistically significant (P0.05), and the higher the risk of the disease, the greater the value. Ogistic regression analysis showed that RDW was the independent influence factor of early PCa, and the OR value reached the highest 2.547 (P0.001). Conclusion: 1, RDW is higher in PCa patients than those of BPH, RDW is an independent influence factor of prostate puncture positive factor.2, RDW can be used to predict prostatic puncture positive, especially for PSA20ng/ml puncture patients. N score and clinical staging are positive correlation, can be used to evaluate the risk of PCa.4, RDW is the highest at early PCa, and it is of great significance for the early detection of PCa in clinical. Second preliminary study of prostate stem cell antigen SNP in prostate biopsy patients: the study of prostate stem cell resistance in prostate biopsy patients. The correlation between the original (PSCA) gene single nucleotide polymorphism (SNP) and prostate cancer (PCa). Methods: analyze the polymorphism of PSCA rs1045531 in prostate biopsy patients and compare the difference in the frequency of rs1045531 genotype distribution between PCa and benign prostatic hyperplasia (BPH) patients, and analyze the polymorphism of the gene and the age of the puncture patient and the prostate special. Correlation between heterosexual antigen (PSA) and Gleason score. Results: the difference in the distribution frequency of PSCA rs1045531 genotypes in group PCa (67 cases) and BPH group (77 cases) was statistically significant (P=0.036). Compared with CC gene, the AC type gene significantly increased the risk of PCa (OR= 2.383,95%CI=1.198-4.741,). The relationship between sex and age, PSA and Gleason scores, the results showed that in all patients with rs1045531 AC, PSA (53.49 + 29.24ng/ml) was significantly higher than that of the CC type (22.42 + 18.74ng/ml) (P=0.019), and PSA (69.89 +, 24.40) was significantly higher in PCa patients. 25). Conclusion: the PSCA rs1045531 AC gene is associated with the risk of PCa and is associated with the PSA of prostate biopsy patients, and can be used to predict the incidence and prognosis of PCa.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.25

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