血清KL-6水平对利妥昔单抗相关间质性肺疾病的诊断意义  

The Significance of Serum KL-6 Level in the Diagnosis of Rituximab Associated Interstitial Lung Disease

作　　者：张佳[1] 张喆 邹外龙[1] ZHANG Jia;ZHANG Zhe;ZOU Wailong(Department of Respiratory and Critical Care Medicine,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院呼吸与危重症医学科,北京100049

出　　处：《标记免疫分析与临床》2024年第6期1125-1129,共5页Labeled Immunoassays and Clinical Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金(编号:320.6750.19089-2)。

摘　　要：目的研究血清涎液化糖链抗原-6(KL-6)水平对利妥昔单抗相关间质性肺疾病(RTX-ILD)的诊断价值。方法选取航天中心医院呼吸与危重症医学科治疗的120例非霍奇金淋巴瘤(NHL)应用利妥昔单抗(RTX)化疗的患者,入组患者于第1次化疗前记录临床资料包括血清KL-6水平等基线值,于第4次化疗前测定血清KL-6水平以及氧分压(PO_(2))等;根据化疗后是否合并ILD,分为RTX-ILD组(51例),不合并ILD组(69例);另外,RTX-ILD组根据临床影像以及症状再分为4级。分析血清KL-6水平与PO_(2)、病情严重程度的相关性。绘制受试者工作曲线(ROC曲线),计算血清KL-6水平诊断RTX-ILD的临界值。结果RTX-ILD组的血清KL-6水平(1201±728U/mL)明显高于不合并ILD组(189±110U/mL),差异具有统计学意义(t=7.125,P<0.05);RTX-ILD组患者第4次治疗前,血清KL-6水平604±321U/mL,差异有统计学意义(χ^(2)=3.56,P<0.05);在临床诊断分级中,G1、G2、G3、G4级分组间的血清KL-6水平分别为989±589U/mL、1175±699U/mL、1204±836U/mL、1332±994U/mL,差异有统计学意义(χ^(2)=4.34,P<0.05)。相关性分析结果显示,血清KL-6水平与动脉血气分析PO_(2)呈负相关(r=-0.827,P<0.05)。血清KL-6检测的临界值为520U/mL时,其诊断RTX-ILD的灵敏度和特异性分别为83.2%(95%CI 70.3%~90.1%)和77.0%(95%CI 73.4%~84.3%),ROC曲线下面积为0.798。结论血清KL-6水平在NHL应用RTX化疗的患者中随着罹患RTX-ILD风险增高而升高,是潜在预测RTX-ILD指标,血清KL-6水平测定有利于RTX-ILD的诊断及病情的评估。Objective To investigate the diagnostic value of serum Krebs Von den Lungen-6(KL-6)levels in rituximab induced interstitial lung disease(RTX-ILD).Methods 120 patients with non-hodgkin’s lymphoma(NHL)treated with rituximab(RTX)chemotherapy in the Respiratory and Critical Care Medicine Department of the Aerospace Center Hospital were selected for the study.Clinical data,including baseline values such as serum KL-6 concentration,were recorded before the first chemotherapy,and serum KL-6 concentration and partial oxygen pressure(PO_(2))were measured before the fourth chemotherapy;According to whether ILD was present after chemotherapy,these patients were divided into the RTX-ILD group(51 cases)and non-ILD group(69 cases);In addition,the RTX-ILD group was further divided into four levels based on clinical imaging and symptoms.The correlation between serum KL-6 concentration,PO_(2),and severity of the disease was analyzed.The receiver operating curve(ROC curve)was plotted to calculate the critical value of serum KL-6 concentration for diagnosing RTX-ILD concentration.Results The serum KL-6 concentration in the RTX-ILD group(1201±728U/mL)was significantly higher than that in the non-ILD group(189±110U/mL)(t=7.125,P<0.05);Before the fourth treatment,the serum KL-6 concentration in the RTX-ILD group was 604±321U/mL,with a statistically significant difference( χ^(2)=3.56,P<0.05);In clinical diagnostic grading,the serum KL-6 concentrations between G1,G2,G3,and G4 groups were statistically significant( χ^(2)=4.34,P<0.05).The correlation analysis results showed a negative correlation between serum KL-6 levels and arterial blood gas analysis results of PO_(2)(r=-0.827,P<0.05).The critical value for serum KL-6 detection was 520 U/mL.The sensitivity and specificity of RTX-ILD diagnosis were 83.2%(95%CI 70.3%90.1%)and 77.0%(95%CI 73.4%84.3%),respectively.The area under the ROC curve was 0.798.Conclusion Serum KL-6 concentration increases with the increased risk of RTX-ILD in patients receiving RTX chemotherapy for non-hodg

关 键 词：肺疾病 间质性 利妥昔单抗 诊断 涎液化糖链抗原-6 

分 类 号：R563[医药卫生—呼吸系统]