血清趋化因子-4检测对系统性硬化病并发肺间质病变的诊断价值

Diagnostic value of clinical significance of serum chemokine-4 detection in patients with systemic scler-osis complicated with interstitial lung disease

目的通过检测系统性硬化病并发肺间质病变（SSc-ILD）患者血清趋化因子-4（CXCL-4）的浓度，探讨其在SSc-ILD的临床意义。方法回顾2015年9月至2017年7月在江西省人民医院风湿免疫科住院且符合2013年ACR/EULAR SSc新分类标准的SSc患者62例，根据高分辨率CT（HRCT）检查结果，参照2013年美国胸科协会/欧洲呼吸协会（ATS/ERS）制定的ILD诊断标准，将纳入的研究对象分为SSc-ILD组和单纯SSc组。选取35例江西省人民医院体检的健康人作为健康对照组。用ELISA法测定纳入研究者的血清CXCL-4浓度，分析3组间CXCL-4浓度是否存在差异。统计学方法采用t检验、秩和检验、χ2检验及Logistic回归分析。结果SSc-ILD组CXCL-4水平[（133±17）ng/ml]较单纯SSc组[（122±19）ng/ml]及健康对照组[（115±19）ng/ml]均升高（t=11.414，P=0.012；t=17.917，P=0.000），而单纯SSc组与健康对照组之间CXCL-4水平差异无统计学意义（t=6.504，P=0.130）；二元Logistic回归分析发现CXCL-4的水平和ILD的发生呈正相关[P=0.019，OR=1.035，95%CI（1.006，1.066）]。结论SSc患者CXCL-4血清水平升高可能与并发ILD有关，CXCL-4有望成为SSc-ILD患者早期诊断和评估的新型血清学标记物，CXCL-4或可作为评价SSc-ILD患者病情及预后的敏感指标，为临床指导SSc-ILD治疗提供新的靶点。

Objective To investigate the clinical significance of serum chemokine-4（CXCL-4） in systemic sclerosis （SSc） patients complicated with SSc-interstitial lung disease （SSc-ILD）.Methods Sixty-two patients with SSc who met the new classification criteria of American College of Rheumatology/European League Against Rheumatism （ACR/EULAR） SSc in 2013 and were treated by rheumatology department of Jiangxi Provincial People＇s Hospital from September 2015 to July 2017 were divided into the SSc combined with ILD group （30 cases） and simple SSc group （32 cases） according to the results of HRCT test, in reference to the 2013 American Thoracic Society/European Respiratory Society （ATS/ERS） ILD diagnostic criteria. A certain number of healthy subjects were selected as healthy control group （35 cases）. Serum concentrations of CXCL-4 were determined by enzyme-linked immunosorbent assay （ELISA）, and the difference of CXCL-4 concentration among the 3 groups were analyzed. All data were analyzed by t test, χ2 test, rank-sum test and Logistic regressive analysis.Results The level of CXCL-4 in the SSc-ILD group [（133±17） ng/ml] was higher than that of the SSc group [（122±19） ng/ml] and normal control group [（115±19） ng/ml] （t=11.414, P=0.012; t=17.917, P=0.000） ; there was no significant difference between the SSc group and the normal control group （t=6.504, P=0.130）; binary Logistic regression analysis found that the level of CXCL4 was positively correlated with ILD [P=0.019, OR=1.035, 95%CI（1.006, 1.066）].Conclusion Elevated levels of CXCL-4 in patients with SSc may be associated with concurrent ILD, CXCL-4 is expected to be a new serological marker for early diagnosis and evaluation of patients with SSc-ILD. It may be used as a sensitive indicator for evaluating the condition and prognosis of patients with SSc-ILD and provide a new target for clinical guidance of SSc-ILD therapy.