剪切波弹性成像联合tPSA及ALP对前列腺癌骨转移的诊断价值

Diagnostic Value of Shear Wave Elastography Combined with tPSA and ALP in Prostate Cancer Bone Metastasis

摘要: 目的：探讨经直肠剪切波弹性成像(SWE)联合总前列腺特异性抗原(tPSA)及ALP (碱性磷酸酶)等临床指标对前列腺癌骨转移的诊断价值。方法：收集2020年10月至2023年7月于延安大学附属医院就诊的62例超声引导下穿刺活检确诊为前列腺癌的患者，并收集临床资料，通过超声剪切波弹性成像测定弹性指标Emax、Emean、Emin，根据全身骨扫描结果将研究对象分为骨转移阴性组和阳性组。比较两组一般临床特征、实验室指标及SWE参数差异，使用logistic回归确定前列腺癌骨转移发生的临床独立危险因素，通过受试者工作特征(ROC)曲线分析各指标的截断值、敏感度及特异性等。结果：62例患者中，骨转移组15例，非骨转移组47例。前列腺癌骨转移组患者血清tPSA、fPSA、%fPSA、PSAD及ALP均高于非骨转移组；当Emean ≥ 100.48 kPa时，诊断前列腺癌骨转移的灵敏度、特异度分别为0.867、0.830；随着Gleason评分及PI-RADS评分等升高，骨转移组人数占比也随之升高；单因素及多因素Logistic回归分析表明，tPSA、ALP及Emean是前列腺癌骨转移的独立危险因素，联合此三者时诊断前列腺癌骨转移的曲线下面积(AUC)为0.959，灵敏度为0.930、特异度为0.894，均高于Emean与tPSA、ALP单独诊断。结论：经直肠剪切波弹性成像(SWE)参数Emean对前列腺癌患者骨转移的诊断有一定价值，联合总前列腺特异性抗原(tPSA)、碱性磷酸酶(ALP)能够提高对前列腺癌骨转移的诊断效能，有助于临床早期预测前列腺癌患者骨转移的风险，评估全身骨扫描检查的必要性。

Abstract: Objective: To explore the diagnostic value of transrectal shear wave elastography (SWE) combined with clinical indicators such as total prostate-specific antigen (tPSA) and ALP (alkaline phosphatase) for prostate cancer bone metastasis. Methods: A total of 62 patients diagnosed with prostate cancer by ultrasound-guided puncture biopsy who visited the Affiliated Hospital of Yan’an University from October 2020 to July 2023 were enrolled, and clinical data were collected. The elasticity indicators Emax, Emean, and Emin were measured by ultrasound shear wave elastography. According to the results of whole-body bone scan, the subjects were divided into a bone metastasis negative group and a positive group. The general clinical characteristics, laboratory indicators, and SWE parameters of the two groups were compared. Logistic regression was used to determine the clinical independent risk factors for prostate cancer bone metastasis. The cutoff value, sensitivity, and specificity of each indicator were analyzed by the receiver operating characteristic (ROC) curve. Results: Among the 62 patients, 15 were in the bone metastasis group and 47 were in the non-bone metastasis group. The serum tPSA, fPSA, %fPSA, PSAD and ALP of patients with prostate cancer bone metastasis were higher than those of patients without bone metastasis. When Emean ≥ 100.48 kPa, the sensitivity and specificity of diagnosing prostate cancer bone metastasis were 0.867 and 0.830 respectively. With the increase of Gleason score and PI-RADS score, the proportion of patients with bone metastasis also increased. Univariate and multivariate Logistic regression analysis showed that tPSA, ALP and Emean were independent risk factors for prostate cancer bone metastasis. When these three factors were combined, the area under the curve (AUC) for diagnosing prostate cancer bone metastasis was 0.959, with a sensitivity of 0.930 and a specificity of 0.894, which were all higher than the diagnosis of Emean, tPSA and ALP alone. Conclusion: Transrectal shear wave elastography (SWE) parameter Emean has a certain value in the diagnosis of bone metastasis in patients with prostate cancer. Combining total prostate specific antigen (tPSA) and alkaline phosphatase (ALP) can improve the diagnostic efficacy of prostate cancer bone metastasis, help to predict the risk of bone metastasis in patients with prostate cancer in the early clinical stage, and evaluate the necessity of whole body bone scanning.