细胞角蛋白19片段改良超声与结缔组织病伴间质性肺疾病的相关性研究  

Study on the correlation of cyfra21-1 and modified ultrasound in connective tissue disease associated with interstitial lung disease

作　　者：萧贵锋 唐鹏芳 罗玮雯 李拾林[2] 陈真[1] Xiao Guifeng;Tang Pengfang;Luo Weiwen;Li Shilin;Chen Zhen(Department of Rheumatology and Immunology,the Second Hospital of Fujian Medical University,Quanzhou 362000,China;Department of Ultrasound Medicine,the Second Hospital of Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院风湿免疫科,泉州362000 [2]福建医科大学附属第二医院超声医学科,泉州362000

出　　处：《中华风湿病学杂志》2023年第1期34-38,共5页Chinese Journal of Rheumatology

基　　金：福建省自然科学基金(2020J01219)。

摘　　要：目的探讨细胞角蛋白19片段(CYFRA21-1)、改良超声与结缔组织病伴间质性肺疾病(CTD-ILD)的相关性。方法回顾性收集2019年9月至2021年12月于福建医科大学附属第二医院风湿免疫科住院的CTD患者112例,CTD-ILD组60例,结缔组织病不伴间质性肺疾病组(CTD-noILD)52例。采用t检验、χ^(2)检验,比较2组患者的人口学特征及肿瘤相关抗原等。进行改良超声评分及高分辨率CT(HRCT)Warrick评分,通过皮尔逊相关性分析评价CYFRA21-1、改良超声评分与Warrick评分的关系,进行CYFRA21-1、改良超声对CTD-ILD的诊断效能评价,并对各指标进行二元Logistic回归分析。结果CTD-ILD组患者CYFRA21-1浓度高于CTD-noILD组[5.74(4.25,9.79)ng/ml与2.79(2.21,3.23)ng/ml,Z=45.94,P<0.001],CTD-ILD组患者改良超声评分高于CTD-noILD组[44.5(36.5,60.0)分与5.0(3.2,6.8)分,P<0.001]。改良超声评分与Warrick评分呈正相关(r=0.93,P<0.001),CYRFA21-1与改良超声评分呈正相关(r=0.387,P=0.042)。CYFRA21-1判断CTD-ILD的灵敏度为81.7%,特异度为92.3%[AUC(95%CI)=0.88(0.81,0.95),P<0.001],改良超声B线判断CTD-ILD的灵敏度为96.4%,特异度为92.9%[AUC(95%CI)=0.99(0.97,1.00),P<0.001]。具有吸烟史[OR(95%CI)=9.26(1.11,77.12),P=0.040]、CYFRA21-1浓度升高[OR(95%CI)=19.40(4.89,76.95),P<0.001]是CTD-ILD的危险因素。结论CYFRA21-1有望成为提示CTD患者并发ILD的血清标志物。改良超声B线判断CTD患者并发ILD具有良好的诊断效能,可以反映CTD-ILD患者肺纤维化严重程度。Objective To investigate the correlation between cytokeratin 19 fragment(CYFRA21-1),modified ultrasound B-line and connective tissue disease associated with interstitial lung disease(CTD-ILD).Methods The data of 112 patients with CTD hospitalized in the Department of Rheumatology and Immunology of the Second Hospital of Fujian Medical University from September 2019 to December 2021 were retrospectively collected.Sixty patients in the CTD-ILD group and 52 patients in the connective tissue disease without interstitial lung disease(CTD-noILD)group were included.The t-test andχ^(2) test were used to compare the demographic characteristics and tumor-associated antigens of the two groups of patients.Modified ultrasound score and HRCT Warrick score were evaluated by Pearson correlation analysis.In addition,the relationship between CYFRA21-1,modified ultrasound score and Warrick score were evaluated,and the diagnostic efficacy of CYFRA21-1 and modified ultrasound of CTD-ILD was evaluated and analyzed by binary logistic regression analysis.Results Patients in the CTD-ILD group had higher CYFRA21-1 concentrations than the CTD-no-ILD group[5.74(4.25,9.79)ng/ml vs.2.79(2.21,3.23)ng/ml,Z=45.94,P<0.001],patients in the CTD-ILD group had higher modified ultrasound scores than the CTD-no-ILD group[44.5(36.5,60.0)vs.5.0(3.2,6.8),P<0.001].Modified ultrasound score was positively correlated with Warrick score(r=0.93,P<0.001)and CYRFA21-1 was positively correlated with modified ultrasound score(r=0.39,P=0.042).The sensitivity of CYFRA21-1 in determining CTD-ILD was 81.7%and the specificity was 92.3%[AUC(95%CI)=0.88(0.81,0.95),P<0.001],the sensitivity of modified ultrasound B-line to determine CTD-ILD was 96.4%and the specificity was 92.9%[AUC(95%CI)=0.99(0.97,1.00),P<0.001].History of smoking[OR(95%CI)=9.26(1.11,77.12),P=0.040]and elevated CYFRA21-1 concentration[OR(95%CI)=19.40(4.89,76.95),P<0.001]were risk factors for CTD-ILD.Conclusion CYFRA21-1 is expected to be a serum marker indicating concomitant ILD in patients with CTD.Mod

关 键 词：结缔组织疾病 肺疾病 间质性 角蛋白19 改良超声 B线 

分 类 号：R593.2[医药卫生—内科学] R563[医药卫生—临床医学]