抗中性粒细胞胞浆抗体相关性血管炎合并肺间质病变患者血清KL-6水平分析

Analysis of serum KL-6 level in patients with antineutrophil cytoplasm antibody associated vasculitis and pulmonary interstitial disease

目的探讨血清KL-6对抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)合并肺间质病变(ILD)的临床价值。方法纳入郑州大学第一附属医院2016年1月至2018年7月收治的90例AAV患者,其中合并ILD无肺部感染者20例、合并ILD有肺部感染者26例、无ILD有肺部感染者21例和无ILD无肺部感染者23例。选取相同期间单纯肺部感染者20例、正常人20例作为对照。应用ELISA法测定上述6组患者血清KL-6水平,分析其与AAV合并ILD疾病的诊断、肺部病情变化及疾病预后的相关性。结果合并ILD无肺部感染组与无ILD无肺部感染、肺部感染、正常人3组血清KL-6水平比较,差异有统计学意义(P<0.05)。合并ILD无肺部感染组与合并ILD有肺部感染组血清KL-6水平比较,差异无统计学意义(P>0.05)。血清KL-6水平与AVV合并ILD患者胸闷症状呈正相关,与用力肺活量(FVC)和一氧化碳弥散量(DLCO)呈负相关,与血沉(ESR)、C反应蛋白(CRP)、肌酐的升高、ANCA阳性无关。合并ILD患者中6例肺间质病变加重,监测血清KL-6水平持续升高。结论血清KL-6可作为AAV合并ILD的一种相关标志物,可用来监测肺部病情变化。高水平的血清KL-6可能提示疾病预后不良。

Objective To investigate the clinical value of serum KL-6 in the treatment of antineutrophil cytoplasm antibody(ANCA)associated vasculitis(AAV)and pulmonary interstitial disease(ILD).Methods Inclusion of 90 patients with AAV admitted to the First Affiliated Hospital of Zhengzhou University from January 2016 to July 2018,20 patients with ILD without pulmonary infection,26 patients with ILD with pulmonary infection,21 patients without ILD with pulmonary infection and 23 patients without ILD without pulmonary infection.Another 20 patients with simple pulmonary infection and 20 normal subjects were selected as controls.Serum KL-6 levels in the above 6 groups were determined by ELISA.The correlations between serum KL-6 level and AAV associated with ILD in diagnosis of disease,lung disease changes and disease prognosis were analyzed.Results There were significant differences in serum KL-6 level among AAV patients with ILD without pulmonary infection with the three groups,without ILD with pulmonary infection,simple pulmonary infection,normal person(P<0.05).The differences between AAV patients with ILD without pulmonary infection and with ILD with pulmonary infection were not significant(P>0.05).Serum KL-6 level was positively correlated with chest tightness in patients with AVV associated with ILD.It had negative correlation with forced vital capacity(FVC)and carbon monoxide diffusing capacity(DLCO),and it had no correlation with blood sedimentation c-reactive protein,creation,or ANCA positive.In 6 cases of AAV patients with ILD,pulmonary interstitial lesion was aggravated,and the serum KL-6 level was continuously increased.Conclusion Serum KL-6 can be used as a serology marker for AAV associated with ILD and to monitor changes in lung disease.High level of serum KL-6 may lead to poor prognosis.