结缔组织病间质性肺病血清涎液化糖链抗原-6肺泡表面活性蛋白A和D及白细胞介素-6的变化及意义

The expression and significance of Krebs von den lungen-6, pulmonary surfactant protein-A, D, interleukin-6 in patients with connective tissue diseases interstitial pulmonary disease

目的测定涎液化糖链抗原-6（KL-6）、肺泡表面活性蛋白（SP）-A、SP—D和IL-6在CTD间质性肺病（ILO）O~的水平及意义。方法检测全部研究对象血清KL-6、SP-A、SP-D、IL-6水平，记录影像学及肺功能情况等，采用t检验、r检验，非参数检验，方差分析及相关分析。结果①CTD-ILD组血清KL-6、SP-A、SP-D、IL-6水平[551．4（428．2，883．5）U／ml、938．4（435．2，2324．7）pg／ml、90．7（80．7，100．3）ng／ml和30．4（22．9，41．7）p咖1]显著高于无ILD的CTD组[192．9（139．2，266．2）U／ml；458．0（372．6，529．0）pg/ml；80．0（71．2，98．3）ng／ml；18．6（4．9，31．0）pg／ml，Z=-5．383，-3．76，-2．123，-3．903，P均〈0．05）；l司时也明显高于健康对照组（30名）[183．2（141．9，216．6）U／ml；229．0（162．0，248．0）pg／ml；50．8（26．1，96．4）ng／ml；7．1（3．7，8．7）Dg／ml，Z=-5．801，-8．13，2．272，3．266；P均〈O．05]。②肺部高分辨率CT（HRCT）为活动性ILD组KL．6显著高于非活动性ILD组[998．5（640．3，1293．3）U／ml与565．O（434．0，799．5）U／ml，Z=2．182，P=0．023]，2组间SP-A、SP—D、IL-6水平差异无统计学意义。③Spearman相关分析：KL-6与用力肺活量（FVC％）呈负相关；SP-D、IL-6与一氧化碳弥散量（DLCO）呈负相关。④Logistie回归分析：KL-6[OR=1．017，P：0．002，95％C／（1．006，1．028）]、SP—A[DR=1.023，P=0．009，95％CI（1．006，1．041）j、SP—D[OR=1．175，P=-O．009，95％C／（1．075，1．264）]、IL-6[OR=1．213，P=O．001，95％CI（1．088，1．354）]是ILD的危险因素。结论CTD—ILD血清KL-6、SP—A、SP—D和IL-6明显升高并显著相关，KL-6与肺部渗出性病变及肺活量有关，SP-D、IL-6与弥散功能有关。

Objective To determine the levels and significance of Krebs yon den lungen-6（KL-6）, pulmonary surfactant protein A （SP-A）, SP-D and interleukin （IL）-6 in patients with connective tissue disease interstitial lung disease （CTD-ILD）. Methods The serum KL-6, SP-A, SP-D and IL-6 in all subjects were detected and the imaging and pulmonary function were recorded t test, X2 test, non-parametric test, ANOVA and correlation analysis were used for data analysis. Results （1） The levels of serum KL-6, SP-A, SP-D, IL-6 in the CTD-ILD group [551.4（428.2, 883.5） U/ml, 938.4（435.2, 2324.7） pg/ml, 90.7（80.7, 100.3） ng/ml and 30.4 （22.9, 41.7） pg/ml; P all〈0.05] was significantly higher than that in the CTD group [192.9（139.2, 266.2） U/ml; 458.0（372.6, 529.0） pg/ml; 80.0（71.2, 98.3） ng/ml; 18.6（4.9, 31.0） pg/ml, Z=-5.383, -3.76, -2.123, -3.903, P all 〈0.05]; and higher than healthy controls （n=30） [183.2（141.9, 216.6） U/ml; 229.0（162.0, 248.0） pg/ml; 50.8（26.1, 96.4） ng/ml; 7.1（3.7, 8.7） pg/ml, Z=-5.801, -8.13, 2.272, 3.266; P all〈0.05]. （2） The levels of KL-6 in pulmonary HRCT for active ILD group was significantly higher than the non-active ILD group [998.5 （640.3, 1293.3） U/ml vs 565.0（434.0, 799.5） U/ml, Z=2.182, P=-0.023], there was no statistical difference in the levels of SP-A, SP-D, IL-6 between the 2 groups. （3） Spearman correlation analysis showed that KL-6 was negatively correlated with forced vital capacity （FVC%）; SP-D, IL-6 and diffusing capacity of carbon monoxide （DLCO %）. （4） Logistic multiple regression analysis showed that KL-6 [OR=1.017, P=0.002, 95%CI（1.006, 1.028）], SP-A [OR=1.023, P=0.009, 95%CI（1.006, 1.041）], SP-D[OR=1.175, P=0.009, 95%CI（1.075, 1.264）], IL-61OR=l.213, P=0.001, 95%CI（1.088, 1.354）] were the risk factors for ILD. Conclusion Serum KL-6, SP- A, SP-D and IL-6 are significantly increased and correlate with CTD-ILD. KL-6 is related to the pulmonary inflammatory disease and vital capacity, while SP-D and IL-6 are related to diffusion function.