趋化因子CX3C配体1在原发性干燥综合征合并间质性肺疾病中的临床意义

The clinical significance of CX3CL1 in primary Sjögren′s syndrome complicated with interstitial lung disease

目的探讨趋化因子CX3C配体1(CX3CL1)在pSS合并间质性肺疾病(ILD)中的临床意义。方法纳入2019年12月至2020年12月桂林医学院附属医院风湿免疫科就诊的pSS患者共103例[合并ILD 42例(pSS-ILD组), 非ILD 61例(pSS组)], 桂林医学院附属医院健康体检中心健康体检者46名(健康对照组);收集入组患者的基本资料、临床表现、临床指标、肺功能、肺高分辨率CT(HRCT)及血清标本;ELISA法检测CX3CL1、涎液化糖链抗原-6(KL-6)在3组血清中的水平, 分析CX3CL1与pSS-ILD和pSS患者的临床相关指标的相关性。采用独立样本t检验。Kruskal-WallisH检验、Pearson相关、Logistic回归分析方法进行统计学分析。结果①CX3CL1、KL-6在pSS-ILD组比pSS组、健康对照组高[CX3CL1:9.08(3.97, 30.56)ng/ml、8.12(6.16, 8.89)ng/ml与7.09(5.86, 9.07)ng/ml, H=3.53, P=0.019;KL-6:19.08(8.05, 24.72)mU/ml、15.9(4.52, 19.26)mU/ml与12.74(8.09, 16.23)mU/ml, H=9.85, P=0.008];CX3CL1与KL-6呈正相关性(r=0.82, P<0.001)。②CX3CL1的截断值为:9.07 ng/ml, 特异度为86.9%, 灵敏度为43.6%。受试者工作特征曲线下面积为0.603。③CX3CL1与一氧化碳弥散量占预计值百分比(r=-0.45, P=0.004)、HRCT评分(r=-0.54, P<0.001)、肺动脉高压(r=0.37, P=0.039)、EULAR关于SS疾病活动指数(ESSDAI)(r=0.36, P=0.049)、胸闷气促(r=0.49, P<0.001)有相关性。结论血清CX3CL1与KL-6、肺纤维化病变及肺功能损伤程度成正比, 趋化因子CX3CL1在一定程度上能帮助pSS-ILD的诊断及病情评估。

Objective To investigate the clinical significance of CX3CL1 in pSS-ILD.Methods A total of 103 pSS patients treated in the Department of Rheumatology and Immunology of the Affiliated Hospital of Guilin Medical College from December 2019 to December 2020 were included(42 cases with ILD and 61 cases without ILD),and 46 healthy physical check-up subjects in the health check-up center of the Affiliated Hospital of Guilin Medical college were included as controls.Demographic data,clinical manifestations,clinical parameters,lung function test,lung HRCT and serum samples of enrolled patients were collected.The serum levels of CX3CL1 and KL-6 in PSS-ILD patients,pSS patients and healthy subjects were detected by ELISA,and the correlation between CX3CL1 and clinical related indexes in pSS-ILD and pSS patients was analyzed.Independent sample t test,Kruskal-Wallis H test,Pearson correlation and Logistic regression analysis were used for statistical analysis.Results As KL-6,the levels of CX3CL1 were significantly higher in the pSS-ILD group compared to both the pSS and control groups[CX3CL1:9.08(3.97,30.56)ng/ml,8.12(6.16,8.89)ng/ml,and 7.09(5.86,9.07)ng/ml,H=3.53,P=0.019;KL-6:19.08(8.05,24.72)mU/ml,15.9(4.52,19.26)mU/ml,12.74(8.09,16.23)mU/ml,H=9.85,P=0.008].Furthermore,CX3CL1 was shown to be positively correlated with KL-6(r=0.82,P<0.001).The cutoff value for CX3CL1 was determined to be at a concentration of 9.07 ng/ml with a specificity of 86.9%and sensitivity of 43.6%.The area under the receiver operating characteristic curve was 0.603.CX3CL1 exhibited significant correlations with predcited carbon monoxide dispersion as a percentage of expected value(r=-0.45,P=0.004),HRCT score(r=0.54,P<0.001),pulmonary hypertension(r=0.37,P=0.039),ESSDAI score(r=0.36,P=0.049),as well as chest tightness and acute breath(coefficient of association r=0.49,P<0.001).Conclusion The level of serum CX3CL1 is directly proportionate to the severity of KL-6,pulmonary fibrosis,and lung function impairment,thereby suggests that CX3CL1 can be utilized as a parameter for the diagnosis and assessment of pSS-ILD.