血清YKL-40在诊断抗黑色素瘤分化相关基因5阳性皮肌炎合并严重肺损伤中的价值  

Value of serum YKL-40 in the diagnosis of anti-MDA5-positive patients with dermatomyositis complicated with severe pulmonary injury

作　　者：张朴丽 杨红霞 张立宁 葛勇鹏 彭清林[1] 王国春[1] 卢昕[1] ZHANG Pu-li;YANG Hong-xia;ZHANG Li-ning;GE Yong-peng;PENG Qing-lin;WANG Guo-chun;LU Xin(Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China;Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China)

机构地区：[1]中日友好医院风湿免疫科 [2]北京大学中日友好临床医学院,北京100029

出　　处：《北京大学学报（医学版）》2021年第6期1055-1060,共6页Journal of Peking University:Health Sciences

基　　金：北京市科技计划课题(Z191100006619012)。

摘　　要：目的:研究血清及支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)中YKL-40(chitinase-3-like-1 protein)在抗黑色素瘤分化相关基因5(anti-melanoma differentiation-associated gene 5,MDA5)阳性皮肌炎(dermatomyositis,DM)合并严重肺损伤中的价值,严重肺损伤包括快速进展间质性肺病(rapidly progressive interstitial lung disease,RP-ILD)和肺部感染。方法:选择2013—2018年中日友好医院风湿免疫科住院的抗MDA5阳性DM患者的病例资料进行回顾性分析,收集患者的人口学信息,临床、实验室及影像学检查资料,应用酶联免疫吸附法检测患者血清和BALF中YKL-40水平。绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under the curve,AUC),评估血清YKL-40对肺损伤的诊断效能。间质性肺病(interstitial lung disease,ILD)由胸部高分辨率CT(high-resolution CT,HRCT)证实。RP-ILD定义为呼吸道症状在3个月内进行性加重,出现呼吸困难和低氧血症,或胸部HRCT显示ILD较之前加重或出现新的ILD。肺部感染经痰、血液、BALF、肺穿刺活检样本检验出病原体确诊。结果:共收集到168例抗MDA5阳性DM患者病例,其中154例合并ILD,66例(39.3%)表现为RP-ILD。经病原学依据证实合并肺部感染患者70例。合并RP-ILD患者中39例(59.1%)合并肺部感染,而非RP-ILD患者仅31例(30.4%)合并肺部感染。RP-ILD合并肺部感染的发生率高于非RP-ILD合并肺部感染者(P<0.001)。血清YKL-40水平在RP-ILD合并肺部感染组高于RP-ILD未合并肺部感染组、非RP-ILD合并肺部感染组和非RP-ILD未合并肺部感染组[83(42~142)vs.42(21~91)vs.43(24~79)vs.38(22~69),P<0.01]。血清YKL-40诊断抗MDA5阳性DM患者RP-ILD合并肺部感染的敏感性、特异性及AUC分别为75%、67%、0.72,其诊断同时存在RP-ILD和肺部感染的抗MDA5阳性DM患者的AUC较诊断仅有RP-ILD和仅有肺部感染者的AUC高,且差异有统计学意义(0.72 vs.0.54和0.55,Z=2.10和2.11,PObjective:To investigate the value of serum and bronchoalveolar lavage fluid(BALF)chitinase-3-like-1 protein(YKL-40)in the diagnosis of anti-melanoma differentiation-associated gene 5(MDA5)-positive dermatomyositis(DM)patients complicated with serious pulmonary injury,including rapidly progressive interstitial lung disease(RP-ILD)and pulmonary infection.Methods:Anti-MDA5 antibodies positive patients with DM who were hospitalized in the Department of Rheumatology of China-Japan Friendship Hospital from 2013 to 2018 were involved in this study.Demographic information,clinical,laboratory and imaging data were retrospectively collected.ELISA was used to detect the serum and BALF levels of YKL-40.The receiver operating characteristic(ROC)curve was drawn,and the area under ROC curve(AUC)was used to evaluate the diagnostic value of serum YKL-40 for pulmonary injury.Interstitial lung disease(ILD)was confirmed by chest high-resolution CT(HRCT).RP-ILD was defined as progressive respiratory symptoms such as dyspnea and hypoxemia within 3 months,and/or deterioration of interstitial changes or appearace of new pulmonary interstitial lesions on chest HRCT.Pulmonary infection was considered as positive pathogens detected in qualified sputum,blood,bronchoalveolar lavage fluid or lung biopsy specimens.Results:A total of 168 anti-MDA5-positive DM patients including 108 females and 60 males were enrolled in the study.Of these patients,154 had ILD,and 66(39.3%)of them presented RP-ILD.Seventy patients with pulmonary infection were confirmed by etiology.In the patients with RP-ILD,39(59.1%)of them were complicated with pulmonary infection.While only 31 cases(30.4%)had pulmonary infection in the non-RP-ILD patients.The incidence of pulmonary infection in the patients with RP-ILD was significantly higher than that of those with non-RP-ILD(P<0.001).The serum YKL-40 levels in the RP-ILD patients with pulmonary infection were the highest compared with RP-ILD without pulmonary infection,non-RP-ILD with pulmonary infection and non-RP-ILD wi

关 键 词：YKL-40 皮肌炎 抗MDA5抗体 快速进展间质性肺病 肺部感染 

分 类 号：R593.26[医药卫生—内科学]