血清SP-A、SP-D、HMGB1、KL-6、miR-21与老年急性加重特发性肺纤维化及肺功能的关系

Relationship between Serum SP⁃A,SP⁃D,KL⁃6,miR⁃21 and Acute Exac⁃erbation of Idiopathic Pulmonary Fibrosis and Pulmonary Function in Eld⁃erly Patients

目的 探讨血清表面活性蛋白-A(SP-A)、表面活性蛋白-D(SP-D)、高迁移率族蛋白B1(HMGB1)、涎液化糖链抗原-6(KL-6)、微小核糖核酸-21(miR-21)与老年急性加重特发性肺纤维化(AE-IPF)及肺功能的关系,以提高AE-IPF早期诊断率、防范误诊的发生。方法 选取2023年1月至2024年1月收治的老年AE-IPF患者80例为AE-IPF组,另选择同期就诊的80例老年稳定特发性肺纤维化(IPF)患者为IPF组及50例体检健康老年人为对照组。比较3组血清SP-A、SP-D、HMGB1、KL-6、miR-21及肺功能指标[第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、1 min最大自主通气量(MVV)、1 min最大自主通气量占预计值百分比(MVV%pred)、肺一氧化碳弥散量占预计值百分比(DLCO%pred)]。分析血清SP-A、SP-D、HMGB1、KL-6、miR-21诊断AE-IPF的价值;分析血清SP-A、SP-D、HMGB1、KL-6、miR-21与肺功能指标的相关性。结果 IPF组、AE-IPF组血清SP-A、SP-D、HMGB1、KL-6、miR-21高于对照组,且AE-IPF组高于IPF组(P<0.05)。血清SP-A、SP-D、HMGB1、KL-6、miR-21诊断AE-IPF发生的曲线下面积分别为0.866、0.882、0.890、0.793、0.783,敏感度分别为0.800、0.825、0.800、0.763、0.813。AE-IPF组、IPF组FEV1、FEV1/FVC、FEV1%pred、MVV、MVV%pred、DLCO%pred均低于对照组,AE-IPF组低于IPF组(P<0.05)。血清SP-A、SP-D、HMGB1、KL-6、miR-21与FEV1、FEV1/FVC、FEV1%pred、MVV、MVV%pred、DLCO%pred均呈负相关(P<0.01)。结论 检测血清SP-A、SP-D、HMGB1、KL-6、miR-21表达情况可提高AE-IPF早期诊断率,防范误诊误治的发生。

Objective To investigate the relationship of serum surfactant protein-A(SP-A),serum surfactant protein-D(SP-D),high mobility group box-1 protein(HMGB1),Krebs von den Lungen-6(KL-6),and microribonuclease-21(miR-21)with acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF)and pulmonary function in elderly patients,in order to improve the early diagnosis rate of AE-IPF and prevent misdiagnosis.Methods A total of 80 elderly patients with AE-IPF admitted from January 2023 to January 2024 were selected as AE-IPF group,another 80 elderly patients with stable idiopathic pulmonary fibrosis(IPE)admitted during the same period were selected as IPF group and 50 healthy elderly patients undergoing physical examination were selected as control group.SP-A,SP-D,HMGB1,KL-6,miR-21 and pulmonary function indexes[forced expiratory volume in the first second(FEV1),FEV1/forced vital capacity(FVC),forced expiratory volume in the first second to the predicted value(FEV1%pred),maximum voluntary ventilation(MVV),maximal voluntary ventilation as a percentage of estimated value(MVV%pred),diffusing capacity of the lungs for carbon monoxide as a percentage of estimated value(DLCO%pred)]were compared among the three groups.The diagnostic value of serum SP-A,SP-D,HMGB1,KL-6 and miR-21 in AE-IPF was analyzed,and the correlation between serum SP-A,SP-D,HMGB1,KL-6 and miR-21 and pulmonary function indexes was analyzed.Results SP-A,SP-D,HMGB1,KL-6 and miR-21 in IPF group and AE-IPF group were higher than those in control group,and higher in AE-IPF group than in IPF group(P<0.05).The area under the curve of serum SP-A,SP-D,HMGB1,KL-6,and miR-21 for the diagnosis of AE-IPF was 0.866,0.882,0.890,0.793,and 0.783,respectively,and the sensitivity was 0.800,0.825,0.800,0.763,and 0.813,respectively.FEV1,FEV1/FVC,FEV1%pred,MVV,MVV%pred and DLCO%pred in AE-IPF group and IPF group were lower than those in control group,and lower in AE-IPF group than in IPF group(P<0.05).Serum SP-A,SP-D,HMGB1,KL-6 and miR-21 were negatively correlated with FEV1,FEV1/FVC,FEV1%pred,MVV,MVV%pred and DLCO%pred(P<0.01).Conclusion The detection of the expressions of serum SP-A,SP-D,HMGB1,KL-6 and miR-21 can improve the early diagnosis rate of AE-IPF and prevent misdiagnosis and mistreatment.