摘要
目的探讨血清肺表面活性蛋白-A、D(sP-A,sP-D)的检测在多发性肌炎/皮肌炎(PM/DM)合并间质性肺病(ILD)中的重要意义。方法采用酶联免疫吸附试验(ELISA)方法测定2005年7月至2011年5月中日友好医院的100例PM/DM患者,20例肺部感染患者以及42名健康对照组血清中sP—A,sP—D水平。分析sP.A,sP—D与PM/DM合并ILD的关系及诊断ILD的敏感性及特异性。判断PM/DM临床特点以及预后与血清中sP—A,SP—D水平相关性。结果合并ILD的PM/DM组血清sP—A,SP—D水平分别较未合并ILD的PM/DM组及正常对照组显著升高(均P〈0.01),但与肺部感染组比较差异均无统计学意义(均P〉0.05)。sP.A,sP.D,sP.A+SP.D诊断PM/DM合并ILD的敏感性分别为66.1%、64.3%和80.0%,特异性分别为72.7%、72.7%和70.4%,PM/DM患者血清sP—A水平与血清铁蛋白(r=0.364,P〈0.05)、CRP(r=0.458,P〈0.05)呈显著正相关,而与DLCO%(r=-0.474,P〈0.05)、VC%(r=-0.404,P〈0.05)呈显著负相关。sP-D水平与外周血CD3+T细胞计数(r=-0.244,P〈0.05)、CD4+T细胞(r=-0.277,P〈0.05)存在负相关关系。血清sP—A升高是PM/DM合并ILD死亡的独立危险因素(P〈0.05)。结论sP—A,SP—D可作为PM/DM合并ILD的潜在血清学标志物,对PM/DM合并ILD的诊断具有一定价值,其联合诊断ILD优于单个指标诊断。血清sP-A水平作为PM/DM合并ILD的死亡独立危险因素,对预后有重要的提示作用。
Objective To explore the possible diagnostic values of serum surfactant protein-A (SP- A) and surfaetant protein-D (SP-D) for interstitial lung diseases (ILD) in patients with polymyositis or dermatomyositis (PM/DM). Methods Serum MCP-1 concentrations were measured by enzyme-linked immunosorbent assay (ELISA) in 100 adult PM/DM patients, 20 patients with pulmonary infection and 42 healthy controls. And the association with their clinical features and serum levels of SP-A and SP-D was analyzed. Results The serum levels of SP-A and SP-D in the PM/DM patients with ILD were both significantly higher than those without ILD and healthy controls ( all P 〈 0. 01 ) while there were no significance differences with those with infectious lung diseases ( P 〉 0. 05 ) . The sensitivity of serum abnormal levels of SP-A, SP-D and combination of SP-A and SP-D for ILD in PM/DM patients were 66. 1% , 64. 3% and 80. 0% and the specificity 72. 7%, 72. 7% and 70. 2% respectively. The serum levels of SP-A were positively correlated with serum ferritin and C-reactive protein (CRP) and negatively with percent carbon monoxide diffusing capacity ( DLCO% ) ( r = - 0. 474, P 〈 0. 05 ), VC% ( r = - 0. 404, P 〈 0. 05) while the serum levels of SP-D were negatively correlated with circulating CD3 + T cells ( r =- 0. 244, P 〈 0. 05) and CD4 + T cells ( r = - 0. 277, P 〈 0. 05 ) in PM/DM patients. Furthermore, SP-A was an independent risk factor for death of ILD in PM/DM ( OR 1. 032, 95% CI 1. 006 - 1. 059, P 〈 0. 05). Conclusion SP-A and SP-D may be potential useful serum markers for the diagnosis of ILD in PM/DM patients. And the combined detection of SP-A and SP-D offers a higher sensitivity than either marker alone. As a risk factor, serum SP-A can predict the prognosis of PM/DM patients with ILD.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第31期2182-2185,共4页
National Medical Journal of China
基金
国家自然科学基金(81072457)
北京市科学技术委员会基金(D101100050010018)