肺纤维化血清KL-6、TGF-β、CXCL13水平与病变程度的关系及其联合预测价值  

The relationship between serum KL-6,TGF-βand CXCL13 levels and the severity of pulmonary fibrosis and the value of combined prediction

作　　者：廖明星[1] 潘瑞琪[1] 艾承锦[1] 李珊珊[1] 周新颖[2] LIAO Ming-xing;PAN Rui-qi;AI Cheng-jin;LI Shan-shan;ZHOU Xin-ying(Department of Laboratory,Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610000,Sichuan,China;Department of Teaching and Research,Chengdu University of Traditional Chinese Medicine,Chengdu 610000,Sichuan,China)

机构地区：[1]成都中医药大学附属医院检验科,成都610000 [2]成都中医药大学教研室,成都610000

出　　处：《医学研究生学报》2021年第1期62-67,共6页Journal of Medical Postgraduates

摘　　要：目的肺纤维化患者常规CT呈现与普通间质性肺炎相似征象,早期诊断困难。文中研究血清涎液化糖链抗原6(KL-6)、转化生长因子(TGF)-β、趋化因子13(CXCL13)水平与病变严重程度的关系及其联合预测肺纤维化发生的价值。方法收集成都中医药大学附属医院2017年1月-2019年10月收治89例特发性肺纤维化患者作为纤维化组;并抽取100例健康体检者作为健康组。所有受试均检测血清KL-6、TGF-β、CXCL13水平,进行肺功能检查与呼吸困难程度评分、胸部高分辨CT(HRCT)检查,量化HRCT肺组织受累程度,分析特发性肺纤维化患者血清KL-6、TGF-β、CXCL13水平与肺功能及HRCT受累程度的关系。受试者工作曲线(ROC)分析三者及其联合预测肺纤维化的效能。结果纤维化组血清KL-6、TGF-β、CXCL13水平显著高于健康组(t=19.517、17.311、18.980,P<0.05),肺功能参数TLC、FVC、FEV1%pred、DLCO%pred显著低于健康组(t=-11.732、-10.389、-11.447、-7.044,P<0.05),HRCT评分高于健康组(t=16.505,P<0.05)。HRCT评分≤4分的特异性肺纤维化患者血清KL-6、TGF-β、CXCL13水平明显低于HRCT>4分患者(t=-8.423、-3.346、-10.176,P<0.05)。肺纤维化患者KL-6、TGF-β、CXCL13与肺功能指标FVC、FEV1%pred、DLCO%pred呈负相关(P<0.05),与HRCT评分呈正相关(P<0.05);KL-6、TGF-β与TLC呈负相关(P<0.05)。TGF-β>499.75 pg/mL时,预测特发性肺纤维化敏感度、特异性分别为93.26%、91.43%;KL-6>468.52 U/mL时,预测敏感度、特异性分别为85.39%、82.86%;CXCL13>4.65 ng/mL时,预测敏感度、特异性分别为70.79%、91.43%;三者联合预测效能优于单独预测,敏感度、特异性分别为93.26%、88.57%。结论特发性肺纤维化伴血清KL-6、TGF-β、CXCL13明显上升,且与肺纤维化病变程度、肺功能受损程度呈正相关。三者中TGF-β诊断特发性肺纤维化价值最高,且联合诊断预测效能优于单项诊断。Objective Conventional CT findings in patients with pulmonary fibrosis are similar to those with ordinary interstitial pneumonia,and its early diagnosis is difficult.This paper aims to investigate the relationship between serum Krebs von den Lungen 6(KL-6),transforming growth factor(TGF)β and chemotactic factor13(CXCL13)levels and the severity of pulmonary fibrosis and its value of combined prediction.Methods A total of 89 patients with idiopathic pulmonary fibrosis were selected as the observation group,and 100 healthy people were selected as the control group.All subjects were tested for KL-6,TGF-β and CXCL13 levels.Lung function test,dyspnea scoring and chest high resolution CT(HRCT)were performed,and HRCT lung tissue involvement was quantified.The relationship between serum KL-6,TGF-β and CXCL13 levels and lung function as well as HRCT involvement in patients with idiopathic pulmonary fibrosis was analyzed.The ROC curve was used to analyze the three indexes and their efficiency in the prediction of pulmonary fibrosis.Results The serum KL-6,TGF-β and CXCL13 levels in the observation group were significantly higher than those in the control group(t=19.517,17.311,18.980,P<0.05).The lung function parameters TLC,FVC,FEV1% pred and DLCO% pred were lower than those of the control group(t=-11.732,-10.389,-11.447,-7.044,P<0.05).The HRCT scores were higher than the control group(t=16.505,P<0.05).Serum KL-6,TGF-βand CXCL13 levels in patients with HRCT score≤4 points were significantly lower than those with HRCT score>4 points(t=-8.423,-3.346,-10.176,P<0.05).KL-6,TGF-βand CXCL13 were negatively correlated with lung function indexes FVC,FEV1% pred and DLCO% pred in patients with pulmonary fibrosis(P<0.05),but were positively correlated with HRCT score(P<0.05).KL-6 and TGF-β were negatively correlated with TLC(P<0.05).When TGF-β was higher than 499.75 pg/mL,the sensitivity and specificity for predicting idiopathic pulmonary fibrosis were 93.26% and 91.43%,respectively.When KL-6 was higher than 468.52 U/mL,the sen

关 键 词：肺纤维化 转化生长因子-β 涎液化糖链抗原6 趋化因子13 

分 类 号：R563[医药卫生—呼吸系统]