Department of Urology, Mustafa Kemal University School of Medicine, Antakya, Turkey.
Urology. 2013 Mar;81(3):617-22. doi: 10.1016/j.urology.2012.11.022. Epub 2013 Jan 17.
To investigate the total prostate-specific antigen (tPSA), free PSA (fPSA), and free/total PSA (fPSA/tPSA) ratio in patients with liver cirrhosis (LC) according to the severity of hepatic insufficiency.
Eighty-two male patients with LC were studied. The severity of liver disease was categorized by Child-Pugh score (Child-Pugh A, B, and C). Forty-two age-matched healthy subjects were used as a control group. The tPSA, fPSA, fPSA/tPSA ratio, total prostate volume (TPV), total testosterone (TT), and total protein (TP) were measured. The LC group was compared with the control group in terms of these parameters. In addition, intra-comparison and inter-comparison was made between all the Child-Pugh groups and normal subjects, in terms of these parameters.
The tPSA and fPSA levels in LC cases, Child-Pugh A, Child-Pugh B, and Child-Pugh C groups were significantly decreased compared with the control group. The ratio of fPSA/tPSA in the LC subjects and Child-Pugh A groups significantly increased compared with the control group. TT, TP levels, and TPV in patients with LC were significantly lower compared with the control group and the results were significantly correlated with the Child-Pugh score.
The present study reveals that tPSA and fPSA were decreased in patients with LC in comparison to healthy subjects in terms of 3 mechanisms. First, it might be due to shrunken prostatic volume. Second, it also resulted in decreased levels of testosterone because of the abnormality of hypothalamic-pituitary-testicular axis. Third, it might be the diminished serum protein level in the composition of the PSA.
根据肝功能不全的严重程度，研究肝硬化（LC）患者的总前列腺特异性抗原（tPSA）、游离前列腺特异性抗原（fPSA）和游离/总前列腺特异性抗原（fPSA/tPSA）比值。
研究了 82 名男性 LC 患者。通过 Child-Pugh 评分（Child-Pugh A、B 和 C）对肝脏疾病的严重程度进行分类。42 名年龄匹配的健康受试者作为对照组。测量 tPSA、fPSA、fPSA/tPSA 比值、总前列腺体积（TPV）、总睾酮（TT）和总蛋白（TP）。将 LC 组与对照组进行这些参数比较。此外，还比较了所有 Child-Pugh 组与正常组之间的这些参数的组内比较和组间比较。
与对照组相比，LC 组、Child-Pugh A 组、Child-Pugh B 组和 Child-Pugh C 组的 tPSA 和 fPSA 水平显著降低。LC 患者和 Child-Pugh A 组的 fPSA/tPSA 比值与对照组相比显著升高。与对照组相比，LC 患者的 TT、TP 水平和 TPV 显著降低，且与 Child-Pugh 评分显著相关。
本研究表明，与健康受试者相比，LC 患者的 tPSA 和 fPSA 降低了 3 种机制。首先，可能是由于前列腺体积缩小。其次，也可能是由于下丘脑-垂体-睾丸轴异常导致睾酮水平降低。第三，可能是 PSA 组成中的血清蛋白水平降低。
