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目的:探讨99mTc-MDP骨扫描、血清游离前列腺特异抗原(free prostate-specific antigen,fPSA)、总前列腺特异抗原(total prostate-specific antigen,tPSA)和fPSA/tPSA比值在前列腺癌骨转移诊断中的价值。方法:采集306例前列腺癌患者的血清标本,用电化学发光法检测fPSA和tPSA,并计算出fPSA/tPSA比值,同步行99mTc-MDP骨扫描,骨扫描不能确诊骨转移者再经CT、MRI和病理诊断等最终确诊有无骨转移。结果:306例中,骨转移组占44.44%(136/306),无骨转移组占55.56%(170/306)。99mTc-MDP骨扫描诊断骨转移的灵敏度为94.85%(129/136),特异度为68.24(116/170)。骨转移组的fPSA和tPSA均高于无骨转移组(P<0.01),而fPSA/tPSA比值低于无骨转移组(P<0.01)。当fPSA/tPSA比值<0.10时,骨转移发病率为61.86%(73/118);随着fPSA/tPSA比值增高,骨转移发病率越来越低,当fPSA/tPSA比值>0.20时,骨转移发病率降至25.26%(24/95)。同无骨转移组相比,Ⅰ、Ⅱ和Ⅲ级骨转移病灶组的fPSA和tPSA明显上升,而fPSA/tPSA比值明显下降,均有统计学差异(P<0.01)。随着前列腺癌骨转移病灶数量增至Ⅰ、Ⅱ和Ⅲ级时,其血清fPSA和tPSA含量逐渐上升,Ⅰ、Ⅱ和Ⅲ级各组之间均有统计学差异(P<0.01和P<0.05),而fPSA/tPSA比值在Ⅰ、Ⅱ和Ⅲ级各组别之间无统计学差异(P>0.05)。结论:99mTc-MDP骨扫描诊断前列腺癌骨转移具有极高的灵敏度。fPSA、tPSA和fPSA/tPSA比值可作为诊断前列腺癌骨转移的指标,fPSA和tPSA越高,前列腺癌骨转移病灶数量就越多;fPSA/tPSA比值越低,前列腺癌越容易发生骨转移,但fPSA/tPSA比值大小不可以作为骨转移病灶数量多少的指标。
Objective: To investigate the value of 99mTc-MDP bone scan, free prostate-specific antigen (fPSA), total prostate-specific antigen (tPSA) and fPSA / tPSA ratio in the diagnosis of bone metastases of prostate cancer value. Methods: Serum samples from 306 patients with prostate cancer were collected. The fPSA and tPSA were detected by electrochemiluminescence and the ratio of fPSA / tPSA was calculated. The 99mTc-MDP bone scan was performed simultaneously with bone scan. And the final diagnosis of pathological diagnosis of bone metastases. Results: In 306 cases, bone metastasis accounted for 44.44% (136/306), boneless metastasis accounted for 55.56% (170/306). The sensitivity of 99mTc-MDP bone scan in diagnosing bone metastases was 94.85% (129/136) and specificity was 68.24 (116/170). The fPSA and tPSA in the bone metastasis group were significantly higher than those in the boneless group (P <0.01), while the fPSA / tPSA ratio was lower in the bone metastasis group (P <0.01). The incidence of bone metastasis was 61.86% (73/118) when fPSA / tPSA ratio was lower than 0.10. The incidence of bone metastases was lower and lower with the increase of fPSA / tPSA ratio. When the ratio of fPSA / tPSA was higher than 0.20, bone metastasis The incidence dropped to 25.26% (24/95). Compared with non-bone metastasis group, fPSA and tPSA in grade Ⅰ, Ⅱ and Ⅲ bone metastases group increased significantly, while fPSA / tPSA ratio decreased significantly (all P <0.01). The serum levels of fPSA and tPSA gradually increased with the number of bone metastases of prostate cancer to grade Ⅰ, Ⅱ and Ⅲ, and there were significant differences among the groups Ⅰ, Ⅱ and Ⅲ (P <0.01 and P <0.05) ), While the ratio of fPSA / tPSA was not statistically different between the groups Ⅰ, Ⅱ and Ⅲ (P> 0.05). Conclusion: 99mTc-MDP bone scintigraphy has high sensitivity in the diagnosis of bone metastasis of prostate cancer. The ratio of fPSA, tPSA and fPSA / tPSA can be used as an index for diagnosis of bone metastasis of prostate cancer. The higher the fPSA and tPSA, the more the number of bone metastases of prostate cancer. The lower the ratio of fPSA / tPSA, the more prone to bone metastasis of prostate cancer The ratio of fPSA / tPSA can not be used as an indicator of the number of bone metastases.