血浆纤维蛋白原与前列腺癌骨转移的相关性及诊断价值研究

doi:10.3877/cma.j.issn.1674-3253.2021.02.011

目的

研究血浆纤维蛋白原（Fib）与前列腺癌骨转移的相关性及诊断价值。

方法

回顾性分析2016年1月至2019年12月于张家港市第五人民医院泌尿外科住院治疗的148例前列腺癌患者的临床资料，根据是否存在骨转移分为骨转移组40例和非骨转移组108例。分别记录两组患者血浆Fib、前列腺特异性抗原（PSA）、Gleason评分及肿瘤分期等指标的差异。采用多因素Logistic回归分析检验前列腺癌骨转移危险因素。根据全身核素骨扫描检查结果将骨转移组患者按照病灶数目分为单发骨转移组（18例）和多发骨转移组（22例），比较两组间血浆Fib及PSA水平的差异。应用受试者工作特征（ROC）曲线分析血浆Fib对前列腺癌骨转移的辅助诊断价值。

结果

骨转移组血浆Fib及PSA水平明显高于非骨转移组，且骨转移组Gleason评分>7分及肿瘤分期T3-4患者比例明显高于非骨转移组（P<0.05）。多因素Logistic回归分析的结果显示Fib升高、Gleason评分>7及肿瘤分期T3-4均是前列腺癌骨转移的独立危险因素。多发骨转移组血浆Fib水平均明显高于单发骨转移组（P<0.05），但两组间血浆PSA水平比较差异无统计学意义（P>0.05）。血浆Fib诊断前列腺癌骨转移的ROC曲线下面积AUC）为0.742（95% CI：0.645～0.841）。当血浆Fib诊断临界值取3.61 g/L时，其诊断效能最高，敏感度为68.6％，特异度为76.2％。

结论

血浆Fib水平与前列腺癌骨转移程度呈正相关，并对诊断前列腺癌骨转移具有一定的诊断价值。

关键词: 血浆纤维蛋白原, 前列腺肿瘤, 骨转移, 诊断价值, 相关性

Objective

To explore the correlation and diagnostic value of plasma fibrinogen (Fib) with bone metastasis in prostate cancer patients.

Methods

The clinical data of 148 patients with prostate cancer in the Fifth People's Hospital of Zhangjiagang City from January 2016 to December 2019 were retrospectively analyzed. They were divided into bone metastasis group (n=40) and non-bone metastasis group (n=108). The differences of plasma Fib, prostate specific antigen (PSA), Gleason score and tumor stage were recorded in the two groups. Multi-factor Logistic regression analysis was used to analysis the risk factors of prostate cancer bone metastasis. According to the results of systemic radionuclide bone scan, patients in the bone metastasis group were divided into single bone metastasis group (18 cases) and multiple bone metastasis group (22 cases) according to the number of lesions. The differences in plasma Fib and PSA levels between the two groups were compared. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of plasma Fib in prostate cancer bone metastasis.

Results

The plasma Fib and PSA levels in the bone metastasis group were significantly higher than those in the non-bone metastasis group, and the Gleason score >7 and tumor stage T3-4 patients in the bone metastasis group were significantly more than the non-bone metastasis group (P<0.05). The results of multivariate logistic regression analysis showed that increased Fib, Gleason score >7, and tumor stage T3-4 were all independent risk factors for bone metastasis of prostate cancer.The plasma Fib level in the multiple bone metastasis group was significantly higher than that in the single bone metastasis group (P<0.05), but there was no statistically significant difference in plasma PSA levels between the two groups (P>0.05). The area under the ROC curve (AUC) of plasma Fib used to diagnose bone metastases in prostate cancer was 0.742 (95% CI:0.645 to 0.841). When the diagnostic critical value of plasma Fib is 3.61 g/L, its diagnostic efficiency is the highest, with a sensitivity of 68.6% and a specificity of 76.2%.

Conclusion

he plasma Fib level is positively correlated with the degree of prostate cancer bone metastasis, and has certain diagnostic value for the diagnosis of prostate cancer bone metastasis.

Key words: Plasma fibrinogen, Prostate cancer, Bone metastasis, Diagnostic value, Correlation

表1 两组前列腺癌患者基本资料比较

组别	例数	年龄[岁，(±s)]	高血压(例)	糖尿病(例)	吸烟(例)	饮酒(例)	家族史(例)	肌酐[μmol/L，(±s)]
非骨转移组	108	66±8	16	20	25	29	10	70±14
骨转移组	40	70±9	6	4	8	10	5	74±15
统计值		t=1.514	χ²=0.160	χ²=1.559	χ²=0.167	χ²=0.052	χ²=0.075	t=0.928
组别	WBC[×10⁹/L，(±s)]	N[×10⁹/L，(±s)]	Fib[g/L，(±s)]	PSA[ng/ml，(±s)]	Gleason评分(≤7/>7)	肿瘤分期(T1-2/T3-4)
非骨转移组	7.47±1.19	4.49±1.11	2.50±0.49	30±10	78/30	59/49
骨转移组	8.02±1.37	5.08±0.84	3.89±0.59	82±20	22/18	11/29
统计值	t=1.117	t=1.298	t=4.125^*	t=10.268^*	χ²=3.951^*	χ²=8.619^*

表1 两组前列腺癌患者基本资料比较

组别	例数	年龄[岁，(±s)]	高血压(例)	糖尿病(例)	吸烟(例)	饮酒(例)	家族史(例)	肌酐[μmol/L，(±s)]
非骨转移组	108	66±8	16	20	25	29	10	70±14
骨转移组	40	70±9	6	4	8	10	5	74±15
统计值		t=1.514	χ²=0.160	χ²=1.559	χ²=0.167	χ²=0.052	χ²=0.075	t=0.928
组别	WBC[×10⁹/L，(±s)]	N[×10⁹/L，(±s)]	Fib[g/L，(±s)]	PSA[ng/ml，(±s)]	Gleason评分(≤7/>7)	肿瘤分期(T1-2/T3-4)
非骨转移组	7.47±1.19	4.49±1.11	2.50±0.49	30±10	78/30	59/49
骨转移组	8.02±1.37	5.08±0.84	3.89±0.59	82±20	22/18	11/29
统计值	t=1.117	t=1.298	t=4.125^*	t=10.268^*	χ²=3.951^*	χ²=8.619^*

表2 影响前列腺癌骨转移的多因素Logistic回归分析

变量	B	SE	Wald χ²	P值	OR（95% CI）
Fib	1.128	0.336	11.270	<0.001	3.987(2.025～10.998)
PSA	0.625	0.442	1.999	0.128	1.209(0.658～3.220)
Gleason评分>7	0.889	0.267	11.089	<0.001	1.558(1.197～2.698)
肿瘤分期T3-4	1.005	0.355	8.015	0.003	2.112(1.069～4.187)

表2 影响前列腺癌骨转移的多因素Logistic回归分析

变量	B	SE	Wald χ²	P值	OR（95% CI）
Fib	1.128	0.336	11.270	<0.001	3.987(2.025～10.998)
PSA	0.625	0.442	1.999	0.128	1.209(0.658～3.220)
Gleason评分>7	0.889	0.267	11.089	<0.001	1.558(1.197～2.698)
肿瘤分期T3-4	1.005	0.355	8.015	0.003	2.112(1.069～4.187)

表3 不同组别患者血浆Fib及PSA水平的比较

组别	例数	Fib（g/L）	PSA（ng/mL）
单发骨转移组	18	3.17±0.61	79.22±11.35
多发骨转移组	22	3.92±0.56	85.66±19.38
t值		5.968^*	1.587

表3 不同组别患者血浆Fib及PSA水平的比较

组别	例数	Fib（g/L）	PSA（ng/mL）
单发骨转移组	18	3.17±0.61	79.22±11.35
多发骨转移组	22	3.92±0.56	85.66±19.38
t值		5.968^*	1.587

图1 血浆Fib诊断前列腺癌骨转移的ROC曲线

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Correlation and diagnostic value of plasma fibrinogen with bone metastasis in prostate cancer patients

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Correlation and diagnostic value of plasma fibrinogen with bone metastasis in prostate cancer patients