POSTN、KL-6、SP-A及SP-D作为特发性肺纤维化血清标志物的比较研究  

Comparative study of serum POSTN,KL-6,SP-A,and SP-D as biomarkers of idiopathic pulmonary fibrosis

作　　者：吴诗 刘骅 殷世家 丁震 WU Shi;LIU Hua;YIN Shijia;DING Zhen(Department of Respiratory and Critical Care Medicine,The Third Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230061,P.R.China;Anhui Institutes for Food and Drug Control,Hefei,Anhui 230051,P.R.China)

机构地区：[1]安徽医科大学第三附属医院(合肥市第一人民医院)呼吸与危重症医学科,安徽合肥230061 [2]安徽省食品药品检验研究院,安徽合肥230051

出　　处：《中国呼吸与危重监护杂志》2025年第3期179-185,共7页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：抗炎免疫药物教育部重点实验室(安徽医科大学)开放基金资助项目(KFJJ-2023-01)。

摘　　要：目的探究骨膜蛋白(periostin,POSTN)、血清涎液化糖链抗原6(Krebs von den lungen-6,KL-6)、肺表面活性蛋白A(surfactant protein A,SP-A)及肺表面活性蛋白D(surfactant protein D,SP-D)对于特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)诊断、病情评估的意义并进行比较。方法收集2022年10月—2023年10月安徽医科大学第三附属医院收治的IPF患者55例作为IPF组,细菌性肺炎患者30例及同期健康体检者30例分别作为肺炎对照组和健康对照组。对所有受试者使用酶联免疫吸附法检测血清POSTN、KL-6、SP-A及SP-D水平并进行肺功能检查;对IPF患者进行胸部高分辨率CT(high resolution CT,HRCT)和超声心动图检查,量化出HRCT评分及肺动脉收缩压(pulmonary artery systolic pressure,PASP)。绘制受试者操作特征曲线分析血清POSTN、KL-6、SP-A及SP-D水平对IPF诊断的意义,使用Pearson和Spearman相关性检验分析四者与肺功能、肺动脉收缩压及HRCT评分的关系。结果IPF组血清POSTN、KL-6、SP-A及SP-D水平显著高于肺炎组和健康组(P<0.05),肺炎组血清SP-A、SP-D水平显著高于健康组(P<0.05)。IPF组血清POSTN水平与第1秒用力呼气容积占预计值百分比(forced expiratory volume in the first second as a percentage of predicted value,FEV1%pred)和一氧化碳弥散能力占预计值的百分比(diffusion capacity of the lung for carbon monoxide as a percentage of predicted value,D_(L)CO%pred)呈负相关(P<0.05),KL-6及SP-D水平与FEV_(1)%pred、用力肺活量占预计值百分比(forced vital capacity as a percentage of predicted value,FVC%pred)及D_(L)CO%pred呈负相关(P<0.05),SP-A浓度与D_(L)CO%pred呈负相关,与PASP呈正相关(P<0.05)。IPF组血清POSTN、KL-6、SP-A水平都与HRCT评分呈显著正相关(P<0.01)。结论POSTN是有价值的IPF血清标志物,敏感性与特异性高于KL-6、SP-A、SP-D;POSTN、KL-6、SP-A和SP-D都可用于IPF的诊断和病情评估。Objective To investigate the impact and mechanisms of periostin(POSTN),Krebs von den Lungen-6(KL-6),pulmonary surfactant protein A(SP-A),and pulmonary surfactant protein D(SP-D)on the diagnosis and disease assessment of idiopathic pulmonary fibrosis(IPF),and conduct a comparative analysis.Methods From October 2022 to October 2023,a total of 55 patients diagnosed with IPF and treated at the Third Affiliated Hospital of Anhui Medical University were enrolled as an IPF group.Additionally,30 patients with bacterial pneumonia and 30 healthy individuals undergoing concurrent health examinations during the same period were selected as a pneumonia control group and a healthy control group,respectively.All participants underwent enzyme-linked immunosorbent assay to measure serum levels of POSTN,KL-6,SP-A,and SP-D,along with pulmonary function tests.The IPF patients also underwent highresolution computed tomography(HRCT)and echocardiography to quantify HRCT scores and pulmonary artery systolic pressure(PASP).Receiver operating characteristic(ROC)curves were plotted to analyze the significance of serum POSTN,KL-6,SP-A,and SP-D levels in IPF diagnosis.Pearson and Spearman correlation tests were used to analyze the relationships between these biomarkers and pulmonary function,PASP,and HRCT scores.Results Serum concentrations of POSTN,KL-6,SP-A,and SP-D were significantly elevated in the IPF group compared with the pneumonia group and the healthy controls(P<0.05),while serum levels of SP-A and SP-D were notably higher in the pneumonia group compared with the healthy control group(P<0.05).Within the IPF group,serum POSTN levels were negatively correlated with forced expiratory volume in the first second as a percentage of predicted value(FEV1%pred)and diffusion capacity of the lung for carbon monoxide as a percentage of predicted value(D_LCO%pred)(P<0.05);KL-6 and SP-D levels were also negatively correlated with FEV_1%pred,forced vital capacity as a percentage of predicted value(FVC%pred),and D_LCO%pred(P<0.05);and the concentr

关 键 词：特发性肺纤维化 骨膜蛋白 血清涎液化糖链抗原6 肺表面活性蛋白A 肺表面活性蛋白D 生物标志物 

分 类 号：R56[医药卫生—呼吸系统]