间质性肺病相关特异性血清标志物的分析  

High-specific serum biomarkers for interstitial lung disease

作　　者：徐晓萍[1] 徐磊[1] 秦慧[2] 赵旭霁[2] 李敏[1] XU Xiaoping;XU Lei;QIN Hui;ZHAO Xuqi;LI Min(Department of Clinical Laboratory,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Respiratory,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院检验科,上海200127 [2]上海交通大学医学院附属仁济医院呼吸科,上海200127

出　　处：《检验医学》2018年第9期819-822,共4页Laboratory Medicine

摘　　要：目的寻找用于间质性肺病(ILD)诊断及预后监测的特异的血清学标志物。方法选取ILD患者134例[124例为结缔组织相关性间质性肺病(CTD-ILD)]、普通肺炎患者48例、慢性阻塞性肺疾病(COPD)患者22例、肺癌患者38例、其他肺部疾病患者9例。另选取30名体检健康者作为正常对照组。检测其血清涎液化糖链抗原6(KL-6)、基质金属蛋白酶-3(MMP-3)、纤维连接蛋白(FN)、C反应蛋白(CRP)。采用受试者工作特征(ROC)曲线评估血清KL-6诊断ILD的价值。结果与正常对照组比较,ILD组、肺癌组及普通肺炎组血清KL-6水平明显升高(P<0.01、P<0.05),其中ILD组KL-6水平最高。ILD组、普通肺炎组、COPD组及其他肺部疾病组血清FN水平均明显降低(P<0.01)。肺部疾病各组CRP水平均明显升高(P<0.01)。ROC曲线分析显示,KL-6诊断ILD的曲线下面积为0.814,综合临床诊断的特异性要求,确定最佳临界值为430 U/mL,敏感性为59.4%,特异性为89.8%。ILD组MMP-3水平为155(84.5~290.5)ng/mL,较厂商提供的参考区间升高2~15倍;124例CTD-ILD患者MMP-3的阳性率为84.7%。结论 KL-6、MMP-3对ILD及CTD-ILD的诊断有较好的临床价值。Objective To find high-specific serum biomarkers for the diagnosis and prognosis monitoring of interstitial lung disease(ILD).Methods A total of 134 ILD patients,including 124 patients with connective tissue disease interstitial lung disease(CTD-ILD),were enrolled,and 48 patients with ordinary pneumonia,22 patients with chronic obstructive pulmonary disease(COPD),38 patients with lung cancer and 9 patients with other pulmonary diseases were enrolled as well.Totally,30 healthy subjects were enrolled as healthy control group.Krebs Von den Lungen-6(KL-6),matrix metalloproteinase-3(MMP-3),fibronectin(FN)and C-reactive protein(CRP)were determined.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficiency of KL-6 for ILD.Results Compared with healthy control group,the KL-6 levels of ILD,lung cancer and ordinary pneumonia groups were higher(P<0.01,P<0.05),and the KL-6 level of ILD group was the highest.The FN levels of ILD,ordinary pneumonia and COPD groups decreased(P<0.01).CRP increased in all pulmonary disease groups(P<0.01).ROC curve analysis showed that the area under curve of KL-6 for the diagnosis of ILD was 0.814.The optimal cut-off value for the diagnosis of ILD was 430 U/mL,the sensitivity was 59.4%,and the specificity was 89.8%.The MMP-3 level of ILD group was 155(84.5-290.5)ng/mL,which was 2-15 times higher than normal reference range provided by manufactories.The positive rate of MMP-3 in CTD-ILD group was 84.7%.Conclusions High-specific serum biomarkers,KL-6 and MMP-3,can improve the diagnostic efficiency for ILD and CTD-ILD.

关 键 词：涎液化糖链抗原6 基质金属蛋白酶-3 纤维连接蛋白 C反应蛋白 间质性肺病 

分 类 号：R446.1[医药卫生—诊断学]