血清趋化因子CXCL-10和涎液化糖链抗原6水平在类风湿关节炎合并肺间质病变患者中的诊断和病情评估价值  

Diagnostic significance of serum chemokine CXCL-10 and Krebs von den lungen-6 level in patients with rheumatoid arthritis associated interstitial lung disease

作　　者：闫蕊[1] 柯丹[1] 张妍[1] 李丽[1] 苏焕然 陈伟 孙明霞 刘晓敏[1] 罗靓 YAN Rui;KE Dan;ZHANG Yan;LI Li;SU Huanran;CHEN Wei;SUN Mingxia;LIU Xiaomin;LUO Liang(Department of Rheumatology and Immunology,Beijing Shunyi Hospital,Beijing 101300,China;Department of Radiology,Beijing Shunyi Hospital,Beijing 101300,China;Department of Chinese Medicine,the People’s Hospital of Yubei District of Chongqing,Chongqing 401120,China)

机构地区：[1]北京市顺义区医院风湿免疫科,北京101300 [2]北京市顺义区医院放射科,北京101300 [3]重庆市渝北区人民医院中医科,重庆401120

出　　处：《北京大学学报（医学版）》2024年第6期956-962,共7页Journal of Peking University:Health Sciences

基　　金：重庆市科卫联合中医药科研项目(2024ZYQN002)。

摘　　要：目的:检测CXC趋化因子配体10(CXC motif chemokine 10,CXCL-10)和涎液化糖链抗原6(Krebs von den lungen-6,KL-6)在类风湿关节炎合并肺间质病变(rheumatoid arthritis associated interstitial lung disease,RA-ILD)患者血清中的表达水平,分析其与RA-ILD的相关性,探讨CXCL-10和KL-6对RA-ILD患者病情评价的意义。方法:选择2021年5月至2023年10月在北京市顺义区医院风湿免疫科住院及门诊治疗的169例类风湿关节炎(rheumatoid arthritis,RA)患者的病例资料进行回顾性分析,根据是否合并ILD分为RA-ILD组82例和RA-non-ILD组87例,根据入排标准最终筛选出两组各80例。采用酶联免疫吸附试验检测所有患者血清CXCL-10和KL-6水平,通过1∶1倾向性评分匹配法(propensity score matching,PSM)对两组患者进行匹配,得到组间协变量均衡的样本。比较匹配后的组间差异,分析血清CXCL-10、KL-6与ILD评分(Warrick评分)、临床实验室及肺功能参数之间的相关性,利用二元Logistic回归分析RA患者发生ILD的危险因素,并判断CXCL-10、KL-6对RA-ILD的预测价值。结果:经1∶1 PSM匹配出RA-ILD组和RA-non-ILD组患者各49例。RA-ILD组血清CXCL-10、KL-6水平显著高于RA-non-ILD组[CXCL-10水平64.36(34.01,110.18)ng/L vs.29.80(16.89,40.55)ng/L,P<0.001;KL-6水平360.70(236.35,715.05)U/mL vs.210.69(159.98,255.50)U/mL,P<0.001]。RA-ILD患者血清CXCL-10水平与Warrick评分呈正相关(r=0.378,P=0.007),与用力肺活量(forced vital capacity,FVC)占正常预计值的百分比(FVC%)呈负相关(r=-0.338,P=0.018);KL-6与类风湿因子(rheumatoid factor,RF)呈正相关(r=0.296,P=0.039),与FVC%(r=-0.436,P=0.002)和一氧化碳弥散量(diffusion lung carbon monoxide,DLCO)占预计值的百分比(DLCO%,r=-0.426,P=0.002)呈负相关。单因素和多因素二元Logistic回归分析均提示CXCL-10(OR值分别为1.035、1.023,P均<0.05)、KL-6水平(OR值分别为1.004、1.005,P均<0.05)与ILD呈正相关。分别用CXCL-10和KL-6绘制ROC曲线,曲线下面积分别Objective:To detect the serum level of chemokine CXC motif chemokine 10(CXCL-10)and Krebs von den lungen-6(KL-6)in patients with rheumatoid arthritis associated interstitial lung disease(RA-ILD),and to analyze their correlation with RA-ILD,as well as the significance in RA-ILD.Methods:A total of 169 RA patients were enrolled in the study.According to imaging findings of with and without ILD in high-resolution computed tomography scans of chest,the subjects were divided into RA-ILD group and RA-non-ILD group.According to the inclusion and exclusion criteria,80 patients in each of the two groups were finally selected.Two groups were matched according to the 1∶1 ratio using propensity score matching(PSM).The serum CXCL-10 and KL-6 levels were detected by enzyme-linked immunosorbent assay.The clinical features,laboratory data and medications between the two groups were compared after PSM and the correlation between serum levels and clinical parameters were analyzed.Binary Logistic regression was used to analyze the risk factors of ILD in the RA patients,and the predictive value of CXCL-10 and KL-6 in RA-ILD was evaluated.Results:In this study,49 patients with RA-ILD and 49 patients with RA-non-ILD were selected by PSM.The levels of CXCL-10 and KL-6 in the RA-ILD group[64.36(34.01,110.18)ng/L,360.70(236.35,715.05)U/mL]were significantly higher than those in the RA-non-ILD group[29.80(16.89,40.55)ng/L,210.69(159.98,255.50)U/mL](all P<0.001).The results of correlation analysis showed that the level of serum CXCL-10 was positively correlated with the Warrick score on chest CT(r=0.378,P=0.007)and negatively correlated with the percentage of forced vital capacity to the predicted value(FVC%,r=-0.338,P=0.018).And the level of KL-6 was positively correlated with rheumatoid factor(RF,r=0.296,P=0.039)and negatively correlated with FVC%(r=-0.436,P=0.002)and the percentage of diffusion capacity for carbon monoxide to the predicted value(DLCO%,r=-0.426,P=0.002).Both univariate and multivariate Logistic regression analysis showe

关 键 词：趋化因子 CXC趋化因子配体10 类风湿关节炎 肺间质病变 

分 类 号：R593.22[医药卫生—内科学] R563[医药卫生—临床医学]