特发性与结缔组织病继发性间质性肺炎患者外周血浆KL-6表达及意义  

The expression and clinical significance of plasma KL-6 in patients with idiopathic interstitial pneumonia and secondary interstitial pneumonia associated with connective tissue disease

作　　者：郭利利[1] 曹孟淑[2] 王鑫[2,3] 丁晶晶 陈智勇[4] 王冬梅[5] 蔡后荣[2] GUO Lili;CAO Mengshu;WANG Xin;DING Jingjing;CHEN Zhiyong;WANG Dongmei;CAI Hourong(Department of Clinical Laboratory,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China;Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China;Department of Respiratory Medicine,Jiangning Hospital,Nanjing Medical University,Nanjing,Jiangsu 211100,P.R.China;Department of Rheumatology and Immunology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China;Department of Radiology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院检验科,江苏南京210008 [2]南京大学医学院附属鼓楼医院呼吸与危重症医学科,江苏南京210008 [3]南京医科大学附属江宁医院呼吸内科,江苏南京211100 [4]南京大学医学院附属鼓楼医院风湿免疫科,江苏南京210008 [5]南京大学医学院附属鼓楼医院放射科,江苏南京210008

出　　处：《中国呼吸与危重监护杂志》2019年第2期128-133,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家自然科学基金面上项目(81670059);十三五南京市卫生青年人才培养工程第一层次(QRX17005)

摘　　要：目的比较涎液化糖链抗原-6(KL-6)在特发性及结缔组织病继发间质性肺炎患者外周血浆表达水平的差异并分析其临床意义。方法收集2011年1月至2014年12月期间住院间质性肺炎患者399例临床资料及外周血标本,同时选取50例健康对照者。采用化学发光免疫测定方法测定血浆KL-6水平。将患者分为特发性间质性肺炎组(IIP,n=233)及结缔组织病继发间质性肺炎组(CTD-SIP,n=166);进一步分为普通型间质性肺炎(UIP)型和非UIP型、稳定期(S)-UIP和急性加重期(AE)-UIP亚组。采用SPSS 19.0统计软件比较IIP和CTD-SIP两组及不同亚组间KL-6表达水平的差异。结果 IIP组患者中男性(61.8%)、平均发病年龄[(62.3±12.5)岁]高于CTD-SIP组(均P<0.01)。IIP组及CTD-SIP组患者血浆KL-6分别是(1 822.7±1 505.2)U/ml和(1 846.7±1 625.3)U/ml,均高于健康对照组[(190.2±88.7)U/ml](均P<0.001)。两组患者的外周血浆KL-6、白细胞计数(WBC)、乳酸脱氢酶(LDH)、C反应蛋白(CRP)及血沉之间差异均无统计学意义(P>0.05)。IIP组外周血浆KL-6与WBC(r=0.159,P=0.016)、LDH(r=0.380,P<0.001)、CRP(r=0.158,P=0.015)呈正相关;而CTD-SIP组外周血浆KL-6与LDH(r=0.187,P=0.016)及CRP(r=0.068,P=0.032)水平正相关。血浆KL-6水平在两组的UIP型和非UIP型亚组之间差异均无统计学意义(P>0.05),但在S-UIP和AE-UIP亚亚组之间差异均具有统计学意义(P<0.001和P=0.023)。不同的CTD(原发性干燥综合征,n=90;类风湿性关节炎,n=20;多发性肌炎/皮肌炎,n=26;未分化结缔组织病,n=10;系统性血管炎,n=15;系统性硬化症,n=5)亚组患者中,血浆KL-6水平差异均无统计学意义(P=0.785 2)。结论外周血浆KL-6水平可以作为间质性肺炎的生物学标志物,并可以反映疾病的活动性,但不能区别特发性与继发性间质性肺炎。Objective To compare the expressive differences of plasma Kerbs von den lungen-6(KL-6) in patients with idiopathic interstitial pneumonia(IIP) and connective tissue disease associated secondary interstitial pneumonia(CTD-SIP), and analyze the clinical significances. Methods The clinical data and peripheral blood of 399 inpatients with interstitial pneumonia and 50 healthy controls were collected from January 2011 to December 2014 in Nanjing Drum Tower Hospital. The level of plasma KL-6 was measured by chemiluminescence immunoassay method.The subjects were divided into IIP(n=233) group and CTD-SIP(n=166) group, usual interstitial pneumonia(UIP) pattern and non-UIP pattern, and stable(S) UIP group and acute exacerbation(AE) UIP group. Statistical analyses were performed by using IBM SPSS 19.0(SPSS, Inc., Chicago IL, USA) to compare the differences of plasma KL-6 in groups.Results There were more male subjects(61.8%) in the IIP group, and the average age of(62.3±12.5) years was significantly older(both P<0.01). Plasma KL-6 levels in the IIP [(1 822.7±1 505.2) U/ml) and the CTD-SIP group[(1 846.7±1 625.3) U/ml] were significantly higher than the healthy control group [(190.2±88.7) U/ml](both P<0.001). However, there was no any difference of KL-6, white blood cell count(WBC), lactate dehydrogenase(LDH),C-reactive protein(CRP) and erythrocyte sedimentation rate between the IIP and the CTD-SIP group. The level of plasma KL-6 was positively correlated to WBC, LDH and CRP in the IIP group(r=0.159, P=0.016;r=0.380, P<0.001;r=0.158,P=0.015, respectively);and it was positively correlated to LDH and CRP in the IIP group(r=0.187, P=0.016 and r=0.068,P=0.032) in the CTD-SIP group. There was no significant difference of plasma KL-6 between the UIP and non-UIP subgroups(P>0.05). The difference of plasma KL-6 between the S-UIP and AE-UIP subgroup was significant(P<0.001 and P=0.023). There was no any significant difference of plasma KL-6 among the subgroups with CTD patients(primary Sj?gren’s syndrome, n=90;rheumatoid arthri

关 键 词：间质性肺炎 结缔组织病 涎液化糖链抗原-6 

分 类 号：R563.13[医药卫生—呼吸系统] R446.6[医药卫生—内科学]