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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 149 -153. doi: 10.3877/cma.j.issn.1674-3253.2018.03.002

所属专题： 文献；

临床研究

多参数磁共振成像联合四基因模型提高前列腺癌早期诊断效能的临床研究
冼土增1, 张俊夫1, 罗飞2, 张添辉3, 陈征1, 江东根1, 黄群雄1, 王劲3, 高新1, 庞俊4,†()   
  1. 1. 510630　广州，中山大学附属第三医院泌尿外科
    2. 510630　广州，中山大学附属第三医院内分泌科
    3. 510630　广州，中山大学附属第三医院放射科
    4. 518107　深圳，中山大学附属第七医院泌尿外科
  • 收稿日期:2018-03-01 出版日期:2018-06-01
  • 通信作者: 庞俊
  • 基金资助:
    国家自然科学基金面上项目(81772754); 广东省自然科学基金重大基础研究培育项目(2017A030308009); 广州市科技计划项目(201607010187)

The clinical research of multi-parametric magnetic resonance imaging combined with four-gene model to improve the early diagnostic efficacy of prostate cancer

Tuzeng Xian1, Junfu Zhang1, Fei Luo2, Tianhui Zhang3, Zheng Chen1, Donggen Jiang1, Qunxiong Huang1, Jin Wang3, Xin Gao1, Jun Pang4,†()   

  1. 1. Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    3. Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    4. Department of Urology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
  • Received:2018-03-01 Published:2018-06-01
  • Corresponding author: Jun Pang
  • About author:
    Corresponding author: Pang Jun, Email:
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引用本文：

冼土增, 张俊夫, 罗飞, 张添辉, 陈征, 江东根, 黄群雄, 王劲, 高新, 庞俊. 多参数磁共振成像联合四基因模型提高前列腺癌早期诊断效能的临床研究[J]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(03): 149-153.

Tuzeng Xian, Junfu Zhang, Fei Luo, Tianhui Zhang, Zheng Chen, Donggen Jiang, Qunxiong Huang, Jin Wang, Xin Gao, Jun Pang. The clinical research of multi-parametric magnetic resonance imaging combined with four-gene model to improve the early diagnostic efficacy of prostate cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(03): 149-153.

目的

探究多参数磁共振成像（MP-MRI）联合外周血四基因模型（ITGB5，ERG，TIMP1，TMEM176B）对前列腺癌（PCa）成像的早期诊断效能。

方法

建立外周血四基因PCa诊断模型，对363例疑似PCa患者进行MP-MRI检查和外周血四基因检测（结果只判定阳性或阴性），以前列腺穿刺活检或术后病理结果为金标准，计算MP-MRI、四基因模型、MP-MRI联合四基因模型诊断PCa的灵敏度、特异度、阳性预测值和阴性预测值。

结果

四基因模型单独诊断PCa具有较高的灵敏度（99.0%）和阴性预测值（97.9%）。相比MP-MRI或四基因模型单独诊断PCa的效能，MP-MRI联合四基因模型能显著提高诊断PCa的特异度（86.4%）和阳性预测值（87.5%）。

结论

四基因模型及MP-MRI联合四基因模型是诊断PCa的比较理想的方法，对PCa的早期诊断显示出良好的临床应用前景。

关键词: 前列腺癌, 诊断, 磁共振, 基因模型
Objective

To investigate the early diagnostic efficacy of multi-parametric magnetic resonance imaging (MP-MRI) combined with four-gene model (ITGB5, ERG, TIMP1, TMEM176B) of peripheral blood for prostate cancer (PCa).

Methods

A four-gene diagnostic model of peripheral blood for prostate cancer was firstly established. Then, MP-MRI examination and four-gene detection of peripheral blood were taken in 363 patients with suspected prostate cancer (the results were positive or negative). The prostate biopsy or postoperative pathological results were taken as the gold standard. The sensitivity, specificity, positive predictive value and negative predictive value were calculated for MP-MRI, four-gene model, MP-MRI combined with four-gene model in the diagnosis of prostate cancer, respectively.

Results

The four-gene model alone has higher sensitivity (99.0%) and negative predictive value (97.9%) in the diagnosis of PCa. MP-MRI combined with the four-gene model significantly increased the diagnostic specificity (86.4%) and the positive predictive value (87.5%) for PCa compared with MP-MRI alone or four-gene model alone.

Conclusions

Four-gene model and MP-MRI combined with four-gene model are ideal methods in the diagnosis of prostate cancer, showing good clinical application prospects for the early diagnosis of prostate cancer.

Key words: Prostate cancer, Diagnosis, Magnetic resonance imaging, Gene model
图1 惰性和侵袭性PCa组织中存在明显差异表达的分泌性基因
图2 外周血qRT-PCR检测四基因表达2-ΔΔCT值在40例BPH与40例PCa差异明显
表1 MP-MRI对363例PCa疑似患者的诊断结果
病理诊断 MP-MRI 合计
+ -
PCa 155（77.1%）0 46（22.9%） 201
BPH 51（31.5%） 111（68.5%） 162
合计 206 157 363
表2 四基因模型对363例PCa疑似患者的诊断结果
病理诊断 四基因模型 合计
+ -
PCa 199（99.0%） 2（1.0%） 201
BPH 070（43.2%） 92（56.8%） 162
合计 269 94 363
表3 MP-MRI联合四基因模型对363例PCa疑似患者的诊断结果
病理诊断 MP-MRI+四基因模型 合计
+ -
PCa 154（76.6%） 047（23.4%） 201
BPH 022（13.6%） 140（86.4%） 162
合计 176 187 363
表4 MP-MRI、四基因模型及两者联合诊断PCa的灵敏度和特异度比较
指标 统计值 MP-MRI vs四基因 MP-MRI vs联合 四基因vs联合
灵敏度 χ2 < 42.086 0 0 45
P <0.001 1 <0.001
特异度 χ2 < 4.207 27.034 46.021
P <0.040 <0.001 <0.001
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