KL-6、SP-A 及SP-D对儿童间质性肺疾病早期诊断及预后的评估价值

Value of KL-6,SP-A and SP-D in Early Diagnosis and Prognosis Assessment of Interstitial Lung Disease in Children

【目的】探讨血清涎液化糖链抗原(Krebs von den Lungen-6,KL-6)、肺表面活性物质-A(Surfactant protein A,SP-A)及肺表面活性物质-D(Surfactant protein D,SP-D)对儿童间质性肺疾病(Inter_(s)titial lung disease,ILD)早期诊断及预后的评估价值。【方法】选取2016年3月至2020年7月本院呼吸内科诊治的ILD患儿35例(ILD组),另外选取同期在本院诊治感染性肺炎患儿40例(肺炎组)以及40名健康体检儿童作为对照组,检测三组血清KL-6、SP-A、SP-D水平,并分析其对儿童ILD早期诊断及预后评估的价值。【结果】ILD组血清KL-6、SP-A、SP-D水平高于肺炎组和对照组(P<0.01)。ILD患儿血清KL-6水平与最大肺活量(VC_(max))、与一秒率(FEV1/FVC)呈正相关(r_(s)=0.339,P<0.05),SP-A水平与25%最大呼气流量(MEF25)呈负相关(r_(s)=-0.252,P<0.05);SP-D水平与VC_(max)呈负相关(r_(s)=-0.214,P<0.05);肺间质病变评分与KL-6、SP-A、SP-D呈正相关(r_(s)=0.542、0.618、0.515,P<0.01)。KL-6、SP-A、SP-D三者联合诊断ILD的AUC为0.89、敏感性为83.6%、特异性为97.2%、约登指数为0.81,联合检测对ILD的诊断价值显著高于单独检测(P<0.05)。KL-6、SP-A、SP-D为ILD患儿预后的影响因素(P<0.05)。【结论】KL-6、SP-A、SP-D可作为儿童ILD早期诊断、疾病严重程度及预后的评估指标,三者联合应用可提高诊断ILD的准确性。

【Objective】To analysis the value of Krebs von den Lungen-6(KL-6),lung Surfactant Protein A(SP-A)and lung Surfactant Protein D(SP-D)for the early diagnosis and prognosis assessment of inter_(s)titial lung disease(ILD)in children.【Methods】A total of 35 children with inter_(s)titial lung disease(ILD)hospitalized in Department of Respiratory Medicine of Hunan Children's Hospital from March 2016 to July 2020 were selected as the ILD group,while 40 children hospitalized with infectious pneumonia during the same period were selected as the pneumonia group and 40 healthy children volunteer_(s) were selected as the control group.Clinical data of children in the three groups were collected to detect pulmonary function indicator_(s) of children in the three groups.Kl-6 was detected by chemiluminescent enzyme immunoassay,and SP-A and SP-D were detected by enzyme-linked immunoassay.The value of all three factor_(s) in early diagnosis and prognosis evaluation of inter_(s)titial pulmonary disease was analyzed.【Results】The levels of KL-6,SP-A and SP-D in ILD group were higher than those in pneumonia group and control group(P<0.01).The level of serum KL-6 was positively correlated with maximum vital capacity(VC_(max))and one second rate(FEV1/FVC)(r_(s)=0.339,P<0.05),while the level of SP-A was negatively correlated with 25%maximum expiratory flow(MEF25)(r_(s)=-0.252,P<0.05)and the level of SP-D was negatively correlated with VC_(max)(r_(s)=-0.214,P<0.05).Pulmonary inter_(s)titial lesion score was positively correlated with KL-6,SP-A and SP-D(r_(s)=0.542、0.618、0.515,P<0.01).The AUC,sensitivity,specificity and Youden index of KL-6,SP-A and SP-D combined detection were 0.89,83.6%,97.2%and 0.81,respectively,indicating that the combined detection of three parameteer_(s) was better than the single detection in the diagnosis of ILD.KL-6,SP-A and SP-D were the influencing factor_(s) for the prognosis of ILD children(P<0.05).【Conclusion】KL-6,SP-A and SP-D can be used as indicator_(s) of early diagnosis,disease severity and prognosis of inter_(s)titial lung disease in children,and their combined detection application can improve the diagnostic accuracy.