血清KL-6水平与常见结缔...病并发肺间质病变的关系研究_郑倩倩.pdf

血清 KL 6 水平与常见结缔组织病并发肺间质病变的关系研究郑倩倩魏小松范晓云王涛李志军基金项目:蚌埠医学院2021 年度研究生科研创新计划项目(编号:Byycxz21063)，2021 年度蚌埠医学院第一附属医院高新技术项目(编号:2021193)作者单位:233000安徽蚌埠蚌埠医学院第一附属医院风湿免疫科通信作者:李志军，bblizhijundr163 com 摘要 目的了解血清涎液化糖链抗原(KL 6)在常见结缔组织病(CTD)并发肺间质病变(ILD)患者中的表达水平及其临床意义。方法选取2021 年4 11 月蚌埠医学院第一附属医院收治的187 例 CTD 患者为研究对象，按照结缔组织病有无肺间质病变分为结缔组织病并发肺间质病变(CTD ILD)组 116 例，结缔组织病无肺间质病变(CTD NILD)组 71 例;选取 41 例同期本院体检健康者为对照组。在 CTD ILD 组中，根据肺高分辨 CT(HCT)表现分为急性组和慢性组;根据 HCT 显示的 ILD 累及范围进行分级(1 级，累及范围25%;2 级，25%累及范围50%;3 级，50%累及范围75%;4 级，75%累及范围100%);随后根据 CTD ILD 患者是否合并有肺部感染分为有肺部感染组和无肺部感染组。采用乳胶凝集法测定血清 KL 6 水平，比较不同分组血清 KL 6 水平差异。结果CTD ILD 组血清 KL 6 水平高于 CTD NILD 组和对照组，差异有统计学意义(P 0 05)。CTD ILD 患者血清 KL 6 水平在急性组高于慢性组(P 0 05)，在有肺部感染组和无肺部感染组差异无统计学意义(P 0 05);HCT示 CTD 患者 ILD 累及范围与血清 KL 6 水平成正相关(r=0 681，P 0 05)，且 ILD 累及范围是血清 KL 6 水平的主要影响因素。OC 曲线显示:CTD ILD 患者血清 KL 6 截断值为 207 8 U/mL，灵敏度为 56 0%，特异度为 98 2%。结论检测血清 KL 6 水平在临床上诊断 CTD ILD 及评估其严重程度有一定的应用价值。关键词 结缔组织病;肺间质病变;涎液化糖链抗原;高分辨 CT;肺部感染doi:10.3969/j.issn.1000 0399.2023.01.006elationship between serum KL 6 level and interstitial lung disease in common connective tissue diseasesZHENG Qianqian，WEI Xiaosong，FAN Xiaoyun，WANG Tao，LI ZhijunDepartment of heumatology，the Fist Affiliated Hospital of Bengbu Medical College，Bengbu 233000，ChinaFund project:Postgraduate esearch Innovation Program of Bengbu Medical College in 2021(No Byycxz21063)，2021 High tech Pro-ject of the First Affiliated Hospital of Bengbu Medical College(No 2021193)Correspondent author:LI Zhijun，bblizhijundr163 com Abstract ObjectiveTo investigate the expression level and clinical significance of Krebsvonden Lungen 6(KL 6)in patientswith common connective tissue disease(CTD)complicated with interstitial lung disease(ILD)MethodsOnehundredand eighty sevenpatients with CTD admitted to the First Affiliated Hospital of Bengbu Medical College from April to November 2021 were selected and dividedinto connective tissue disease with interstitial lung disease(CTD ILD)group(116 cases)and connective tissue disease without interstitiallung disease(CTD NILD)group(71 cases)according to whether connective tissue disease had interstitial lung disease or not A total of41 healthy subjects were selected as the control group The CTD ILD group was divided into acute group and chronic group according tolung high resolution CT(HCT)findings ILD was graded according to the extent of HCT(grade 1，involvement range 25%，grade 2，25%involvement range 50%，grade 3，50%involvement range75%，grade 4，75%involvement range100%)Then CTD ILD patients were divided into pulmonary infection group and non pulmonary infection group according to whether they had pulmonary infec-tion or not The serum KL 6 level was measured by latex agglutination method，and the difference of serum KL 6 level in different groupswas compared esultsSerum KL 6 level in CTD ILD group was higher than that in CTD NILD group and control group，and thedifference was statistically significant(P 0 05)Serum KL 6 level in SS patients complicated with ILD was higher than that in SLE andA patients(P 0 05)Serum KL 6 level of CTD ILD patients in the acute group was higher than that in the chronic group(P 0 05)，and there was no significant difference between the pulmonary infection group and the non pulmonary infection group(P 0 05)HCT showed that the extent of ILD involvement was positively correlated with serum KL 6 level in CTD patients(r=0 681，P 0 05)，and the extent of ILD involvement was a risk factor affecting serum KL 6 level The cut off value of serum KL 6 in CTD ILD patients was2078 U/mL ConclusionThedetection of serum KL 6 level has certain application value in the diagnosis and evaluation of CTD ILD Key words Connective tissue disease;Interstitial lung disease;Krebs von den Lungen 6;High resolution CT;Lung infection72第 44 卷第 1 期安徽医学2023 年 1 月Anhui Medical Journal肺间质病变(interstitial lung disease，ILD)是结缔组织病(connective tissue disease，CTD)常见的并发症之一，可严重影响患者的生活质量，也是导致 CTD 患者死亡率升高的主要原因之一1 2。临床表现结合肺高分 辨 CT(high resolution computed tomography，HCT)是诊断 ILD 的常用方法3 4，肺功能检查(pul-monary function tests，PFTs)、肺泡灌洗检查和肺活检等也可用于 ILD 的诊断。然而 PFTs 需要患者高度配合，对于危重患者难以成为常规检查;肺泡灌洗检查和肺活检作为侵入性检查，创伤大、费用高，对于 CTD ILD 的临床诊断及动态监测存在局限性5 6。Kohno 等7 在肺腺癌细胞中发现涎液化糖链抗原(Krebs von denlungen 6，KL 6)，KL 6 在正常组织中主要存在于型肺泡上皮细胞，其表达与肺纤维化有关8，故有学者9 认为血清 KL 6 可作为一种血清生物标志物用于肺纤维化的诊断。本研究的目的就是探究血清KL 6 水平与 CTD ILD 的关系，为临床诊断 CTD ILD 及评估其严重程度提供参考。1资料与方法1 1一般资料选取 2021 年 4 11 月蚌埠医学院第一附属医院收治的187 例 CTD 患者为研究对象，其中结缔组织病并发肺间质病变(connective tissue disease in-terstitial lung disease，CTD ILD)组 116 例，男性 14 例(12 1%)，女性 102 例(87 9%)，年龄(56 24 13 55)岁，病程 3 0(0 5，10 0)年;结缔组织病无肺间质病变(connective tissue disease non interstitial lungdisease，CTD NILD)组 71 例，男性 10 例(14 1%)，女性 61 例(85 9%)，年龄(51 90 15 14)岁，病程 5 0(0 5，10 0)年。选择 41 例同期于本院体检健康者为对照组，男性 19 例(46 3%)，女性 22 例(53 7%)，年龄(45 46 11 34)岁。3 组对象基线资料比较，差异无统计学意义，具有可比性。该研究方案获得蚌埠医学院第一附属医院伦理委员会批准(伦科批字 2022第 314 号)，所有研究对象均知情同意。12纳入与排除标准纳入标准:符合下列现行国际风湿病学会修订的结缔组病诊断(分类)标准，未分化结缔组织病(undifferentiated connective tissue dis-ease，UCTD)。美国胸科学会修订的 UCTD 的建议诊断标准10;类风湿性关节炎(rheumatoid ar