血清标志物联合检测在特发性肺纤维化早期诊断中的价值

Application of Serum Markers in Early Diagnosis of Idiopathic Pulmonary Fibrosis

目的通过分析特发性肺纤维化(IPF)患者的临床资料和血清标志物水平变化,探讨血清标志物在肺纤维化患者早期诊断中的应用价值。方法选取2015年6月~2017年6月间,吉林大学第二医院呼吸内科明确诊断为IPF的患者20例为IPF组,同期选取健康对照组(HC组)10例,支气管哮喘组(Asthma组)6例,慢性阻塞性肺疾病组(COPD组)6例,对4组患者临床资料进行回顾性统计分析。比较4组血清标志物的表达水平,并对各个血清标志物的敏感性及特异性进行对比分析。结果与HC组比较,IPF组血清涎液化糖链抗原(KL-6)、肺表面活性物质结合蛋白A(SP-A)、肺表面活性物质结合蛋白D(SP-D)、人表皮生长因子(EGF)、血管内皮生长因子(VEGF)、趋化因子配体13(CXCL-13)水平均明显高于HC组(P<0.05)。IPF组血清KL-6、SP-D、EGF、VEGF、CXCL-13水平均较Asthma组、COPD组高,差异均有统计学意义(P<0.05)。由ROC曲线可知,诊断IPF各生物指标中,敏感性EGF>CXCL-13>KL-6>SP-D>SP-A>VEGF>趋化因子配体18(CCL-18)。联合指标的AUC值明显大于单个血清标记物的AUC值,当7个标志物联合时所测的AUC值最大,且联合标志物和各单一标志物之间的AUC值差异有统计学意义(P<0.05)。结论7项血清标志物对IPF的早期诊断均有一定意义,联合血清标志物较各单一标志物诊断IPF具有高敏感性和高特异性,对IPF患者管理有更高的成本效益。

Objective To explore the application of serum markers in the early diagnosis of idiopathic pulmonary fibrosis(IPF).Methods From June 2015 to June 2017,20 patients with idiopathic pulmonary fibrosis were included in IPF group.10 healthy persons were as the healthy control group.6 patients with bronchial asthma were included in asthma group.6 patients with chronic obstructive pulmonary disease were included in COPD group.The clinical data were collected and serum markers were detected in 4 groups.The sensitivity and specificity of each serum marker in the diagnosis of IPF were analyzed.Results The levels of serum krebs von den lungen-6(KL-6),surfactant protein A(SP-A),surfactant protein D(SP-D),epidermal growth factor(EGF),vascular endothelial growth factor(VEGF) and CXC chemokine ligand-13(CXCL-13) in IPF group were significantly higher than those in healthy control group(P <0.05).The levels of serum KL-6、SP-D、EGF、VEGF and CXCL-13 in IPF group were significantly higher than those in asthma group and COPD group(P <0.05).ROC curve analysis showed that the sequence of sensitivity of serum markers in the diagnosis of IPF was EGF> CXCL-13> KL-6> SP-D> SP-A> VEGF> CC chemokine ligand 18(CCL-18).AUC value of the combined detection of serum markers was significantly greater than that of detection of single serum marker(P <0.05).Conclusion Detection of serum markers are helpful for the early diagnosis of IPF.Compared with single marker detection,combined detection of serum markers can improve the sensitivity and specificity for the diagnosis of IPF.