类风湿性关节炎伴间质性肺病中肿瘤标志物与肺功能的相关性分析

Correlation of tumor markers with lung function in rheumatoid arthritis accompanied with interstitial lung diseases

目的探讨肿瘤标志物在类风湿性关节炎伴间质性肺病(rheumatoid arthritis with interstitial lung disease,RA-ILD)中的表达及其临床意义。方法收集本院呼吸科2008年1月至2011年1月住院的82例类风湿关节炎患者。根据是否伴有间质性肺病,将其分为RA-ILD组(38例)和RA组(44例),检测两组患者血清肿瘤标志物癌胚抗原(carcinoembryonic antigen,CEA)、糖蛋白抗原15-3(carbohydrate antigen 15-3,CA15-3)、糖蛋白抗原19-9(carbohydrateantigen 19-9,CA19-9)水平,抗环瓜氨酸肽(CCP)抗体水平和肺功能包括用力肺活量(FVC)、第1秒用力呼气量(FEV1)、一氧化碳弥散量(DLCO)占预计值百分比,分析两组患者肿瘤标志物表达差异以及RA-ILD组肿瘤标志物与肺功能、抗CCP抗体相关性。结果 RA-ILD组外周血CEA、CA15-3、CA19-9水平均显著高于RA组(P<0.01);RA-ILD组FVC、FEV1和DLCO占预计值百分比均显著低于RA组(P<0.01),但是RA-ILD组抗CCP抗体水平与RA组无显著性差异(P>0.05)。RA-ILD组CEA水平与FVC、FEV1和DLCO呈负相关(r值分别为-0.499、-0.576、-0.512,P<0.0l),但CEA、CA15-3和CA19-9均与抗CCP抗体无相关性(r值分别为-0.192、-0.264、-0.268)。结论肿瘤标志物CEA、CA15-3和CA19-9在RA-ILD中表达升高,CEA可能反应RA-ILD肺功能受损的严重程度,可能与关节损害无密切相关性。

Objective To explore the correlation of tumor markers with lung function in rheumatoid arthritis （RA） accompanied with interstitial lung diseases. Methods Eighty-two RA inpatients in our hospital from January 2009 to January 2011 were recruited in this study. Among these RA patients, 38 were accompa- nied with interstitial lung diseases, and the left 44 were not. Tumor markers , such as CEA, CA15-3, CA19-9, and pulmonary function indexes, including forced expiratory volume （FVC）, first second forced expiratory volume （FEV1 ）, carbon monoxide diffusion capacity （DLco）, and anti-CCP antibody were detected in all of patients. Correlation between the expression of these markers and pulmonary function indexes, level of anti-CCP antibody was analyzed by Spearman Rank Correlation. Results Serum levels of CEA, CA15-3 and CA19-9 were significantly higher in RA-ILD group than in RA group （ P 〈 0.01 ）. The percentage of predicted value for FVC, FEV1 and DLco was significantly lower in RA-ILD group than in RA group （ P 〈 0.01 ）. There was no significant difference between two groups in anti-CCP level （P 〉0.05 ）. Serum CEA level was inversely corre- lated with FVC（ r = -0.499, P 〈0.01）, FEV^（ r = -0.576, P 〈0.01） and DLco（r = -0.512, P 〈0.01） in RA-ILD patients. There was no correlation between serum level of CEA, CA15-3 and CA19-9 and anti-CCP antibody in RA-ILD patients （ r = - 0. 192, - 0. 264, - 0.268, respectively, P 〉 0.05）. Conclusion The expression of tumor markers, including CEA, CA15-3 and CA19-9 is increased in RA-ILD. CEA level may reflect the degree of lung function impairment in RA-ILD, but have no relation with the joint lesion severity.