对低分化前列腺癌血清PSA变化可能机制的探讨_临床医学论文.docVIP

对低分化前列腺癌血清PSA变化可能机制的探讨_临床医学论文 对低分化前列腺癌血清PSA变化可能机制的探讨_临床医学论文 作者：南勋义，王明珠，贺大林，邢俊平，范晋海，杜岳锋，李祥 【摘要】 目的 探讨低分化前列腺癌患者血清PSA水平升高或降低变化的可能机制，以期提高对此种变化的准确认识和提供临床正确诊治此类疾病的参考。方法 剖析本组20例低分化前列腺癌和2例未分化腺癌血清PSA水平的变化，并结合国内外相关文献报道对PSA变化可能的原因发生机制进行探讨。结果 20例低分化腺癌中有4例PSA略高于正常仅占20%(5.7～27.21 ng/ml，平均16.79 ng/ml)余16例很高，占80%之多的PSA(gt;100～5 000 ng/ml，平均888.16 ng/ml)其平均值超过正常200倍以上。2例未分化腺癌，1例PSA微高4.8 ng/ml，另1例gt;100 ng/ml平均52.4 ng/ml，仍高于正常值12倍之多。结论 文献报道低分化前列腺癌组织本身分泌PSA能力下降和前列腺癌时细胞血屏障破坏，被认为是血清PSA在低分化前列腺癌病例中降低或升高的主要原因和机制。但本组资料显示除此之外低分化前列腺癌血清PSA升高或偏低(与高、中分化腺癌相比)受诸多因素如癌进展的不同阶段、癌的异质性和患者个体差异等多因素影响。总之单一的前列腺癌血屏障破坏或前列腺癌组织分泌PSA能力低下，均不能解释低分化腺癌患者血清PSA变化的极大差异。我们认为最关键的因素为不同患者其癌生存所处的微环境不同以及癌组织结构的不一致性，异质性使得低分化前列腺癌产生，出现血清PSA过高和略高甚至低于正常的变化，这些可能是造成低分化前列腺癌血清PSA差异的基本机制。 【关键词】 前列腺低分化腺癌;血清PSA;血清PSA与癌分化不同的关系 　　[Abstract] Objective To investigate the possible mechanism of serum PSA changes in low-differentiated prostate cancer(PCa)，and on this basis，these changes would be much better understood and the correct diagnosis and treatment of such kind of PCa would be achieved.Methods Serum PSA level in 20 patients diagnosed as low-differentiated PCa and 2 patients with undifferentiated PCa were analyzed.The possible mechanism of serum PSA changes was discussed by referring to civil and overseas literatures.Results 4 cases among the 20 patients with low-differentiated PCa(20%) showed relatively higher level of PSA(5.7～27.21 ng/ml，average 16.79 ng/ml)，while the PSA level of the rest 16 cases(80%) was much higher(100～5 000 ng/ml，average 888.16 ng/ml)，which was 200 times higher than normal level of PSA.One of the 2 patients with undifferentiated PCa showed a relatively higher PSA value as 4.8 ng/ml，while the other indicated a much higher value asgt;100 ng/ml.Average PSA level in the two patients was 52.4 ng/ml，which was still 12 times higher than normal value.Conclusion The decreasing capability of PSA secretion of low-differentiated PCa tissue and destroyed PCa blood-tumor barrier usually are thought as the main reasons and mec