血清KL-6水平对评价结缔组织病间质性肺疾病作用的研究

Serum KL-6 Level as a serological biomarker for interstitial lung disease in patients with connective tissue disease

目的研究血清KL-6在结缔组织病间质性肺疾病(CTD-ILD)诊断、严重程度、活动度评价方面的意义。方法纳入97例CTD-ILD患者、45例CTD无ILD患者及40例健康对照者,收集其一般资料、临床症状、肺功能检查、肺高分辨CT、血清KL-6检查,对各项指标进行比较及相关性分析。结果 CTD-ILD组患者KL-6水平明显高于CTD无ILD组患者及健康对照组[(775.43±580.71)U/mlVS(219.89±123.58)U/ml VS(136.33±70.44)U/ml,P<0.001)。当KL-6取值306.6U/ml时,曲线下面积最大(0.937),此时灵敏度为84.21%,特异度为90.36%。CTD-ILD组有更多的患者出现气短症状。中/重度弥散功能障碍组患者KL-6水平明显高于正常/轻度弥散功能障碍组[(1054±736.89)U/ml VS(498.47±341.63)U/ml,P<0.001]。KL-6与限制性通气功能指标及弥散功能指标呈负相关(P<0.05)。与肺高分辨率CT中病变总面积及毛玻璃影面积呈正相关(r=0.449,0.515;P<0.001)。结论血清KL-6是诊断CTD-ILD以及评价其活动度和严重程度的有效血清标记物。

Objective To evaluate the significance of serum KL-6 glycoprotein level in the diagnosis,severity,activity of interstitial lung disease associated with connective tissue disease（CTD-ILD）.Method Ninety-seven CTD-ILD patients and forty-five CTD patients without ILD were enrolled from August 2015 to March 2016 in the General Hospital of the People＇s Liberation Army,Division of Rheumatology,and forty age and gender matched healthy subjects were enrolled as controls.Their general information,clinical symptom,pulmonary function tests,lung high-resolution CT,serum KL-6 examination were documented.Result Serum KL-6 level in patients with ILD were significantly higher than those in patients with non-ILD pulmonary diseases or in healthy individuals（775.43 ±580.71 U/ml vs219.89±123.58 U/ml or 136.33±70.44 U/ml,all P〈0.001）.At the cut-off value of 306.6 U/ml,the sensitivity and specificity of serum KL-6 as a diagnostic marker for ILD was 84.21%and 90.36%,respectively.The area below the receiver operating characteristic curve was 0.937.The CTD-ILD group is more likely to have short of breath symptom.The middle/heavy diffusion impairment group has higher KL-6 level.KL-6 levels were significantly correlated with restrictive ventilatory function and diffusion function（P〈0.05）.There were positive correlation between serum KL-6 levels and the ground glass area on pulmonary HRCT（r = 0.515,P〈0.001）.Conclusion Serum KL-6 is a useful biomarker in the diagnosis,severity,activity of CTD-ILD.