CTD-ILD患者血清YKL-40和CCL18水平的变化及意义

doi:10.11958/20220567

摘要/Abstract

摘要：

目的探讨结缔组织病相关间质性肺疾病（CTD-ILD）患者血清中甲壳质酶蛋白40（YKL-40）和趋化因子配体18（CCL18）水平变化及临床意义。方法选择已确诊的105例结缔组织病（CTD）患者，其中37例患者合并间质性肺疾病（ILD，CTD-ILD组），68例未合并ILD（CTD组），另选35例健康体检者作为对照组。记录患者的临床资料，并对CTD-ILD患者进行肺部高分辨CT（HRCT）检查。采用酶联免疫吸附试验（ELISA）测定所有研究对象血清中YKL-40和CCL18水平，并分析与肺部HRCT评分的相关性。结果 CTD-ILD组血清YKL-40 、CCL18和CEA水平明显高于CTD组，与对照组比较，CTD-ILD组和CTD组血清YKL-40及CTD-ILD组血清CCL18均明显增高，差异均有统计学意义（均P<0.05）。多因素Logistic回归分析显示，CTD患者血清YKL-40和CCL18水平升高是发生ILD的独立危险因素（P<0.05）。ROC曲线分析显示，血清YKL-40和CCL18诊断CTD-ILD的曲线下面积（AUC）分别为0.648和0.621，两者联合诊断CTD-ILD的AUC为0.663，且敏感度高于YKL-40和CCL18单独诊断。相关性分析显示，CTD-ILD组血清YKL-40和CCL18水平与肺部HRCT评分均呈正相关（r_s分别为0.697、0.472，均P<0.05）。结论 CTD-ILD患者血清中YKL-40和CCL18呈高表达，是CTD发生ILD的独立危险因素，且两者联合检测有助于CTD-ILD患者的早期诊断和病情评估。

关键词: 结缔组织疾病, 肺疾病, 间质性, 甲壳质酶蛋白40, 趋化因子配体18, 高分辨率CT

Abstract:

Objective To explore the expression and clinical significance of serum levels of YKL-40 and CCL18 in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). Methods A total of 105 CTD patients including 37 patients with ILD (the CTD-ILD group), 68 patients without ILD (the CTD group) were enrolled into the study. Thirty healthy people were selected as the control group. Clinical data and the test of high resolution CT (HRCT) were detected in the three groups. The serum levels of YKL-40 and CCL18 were detected by ELISA in the three groups. The correlation between lung HRCT score and YKL-40, CCL18 were analyzed. Results The serum levels of YKL-40, CCL18 and CEA were significantly higher in the CTD-ILD group than those in the CTD group. Comparing with the control group, the serum level of YKL-40 was significantly higher in the CTD-ILD group and the CTD group, and the serum level of CCL18 was significantly higher in the CTD-ILD group (P<0.05). Multivariate Logistic regression analysis showed that higher YKL-40 and CCL18 levels were independent risk factors of ILD in CTD patients (P<0.05). ROC curve analysis showed that areas under the curve (AUC) of serum YKL-40 and CCL18 in the diagnosis of CTD-ILD were 0.648 and 0.621, respectively, while AUC of combined diagnosis of CTD-ILD were 0.663 and their sensitivity were higher than those of YKL-40 and CCL18 alone. Correlation analysis showed that levels of YKL-40 and CCL18 were positively correlated with HRCT scores of the CTD-ILD group (respectively r=0.697 and 0.472, both P<0.05). Conclusion The high serum YKL-40 and CCL18 are highly expressed in CTD-ILD patients, and which are independent risk factors of ILD. The combined detection of serum YKL-40 and CCL18 is helpful for the early diagnosis and severity evaluation of CTD-ILD.

Key words: connective tissue diseases, lung diseases, interstitial, chitinase protein 40, chemokine ligand 18, high resolution CT

中图分类号:

R563，R593.2

图/表 7

参考文献 22

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组别	n	年龄（岁，$\bar{x}±s$）	性别（男/女）	病程（年，$\bar{x}±s$）
对照组	35	52.41±11.03	9/26	-
CTD组	68	54.32±12.78	13/55	5.75±2.39
CTD-ILD组	37	56.51±10.93	8/29	5.64±3.15
F、χ²或t		3.345	2.487	0.278

组别	n	年龄（岁，$\bar{x}±s$）	性别（男/女）	病程（年，$\bar{x}±s$）
对照组	35	52.41±11.03	9/26	-
CTD组	68	54.32±12.78	13/55	5.75±2.39
CTD-ILD组	37	56.51±10.93	8/29	5.64±3.15
F、χ²或t		3.345	2.487	0.278

组别		n	SLE		RA		MCTD
CTD组		68	18（26.83）		15（21.95）		13（19.51）
CTD-ILD组		37	11（29.73）		9（24.32）		7（18.92）
χ²			0.081		0.062		0.004
组别	SSc			SS		SV		PM/DM
CTD组	4（5.88）			10（14.63）		5（7.31）		3（4.88）
CTD-ILD组	6（16.22）			2（5.41）		1（2.71）		1（2.71）
χ²	2.716			1.800		0.851		0.249

组别		n	SLE		RA		MCTD
CTD组		68	18（26.83）		15（21.95）		13（19.51）
CTD-ILD组		37	11（29.73）		9（24.32）		7（18.92）
χ²			0.081		0.062		0.004
组别	SSc			SS		SV		PM/DM
CTD组	4（5.88）			10（14.63）		5（7.31）		3（4.88）
CTD-ILD组	6（16.22）			2（5.41）		1（2.71）		1（2.71）
χ²	2.716			1.800		0.851		0.249

组别	n		YKL-40
对照组	35		992.11（684.11，1 393.47）
CTD组	68		1 834.90（983.04，4 305.33）^a
CTD-ILD组	37		3 858.19（1 440.77，4 863.02）^ab
χ²			12.588^＊＊
组别		CCL18
对照组		393.66（237.51，853.14）
CTD组		618.50（310.84，831.78）
CTD-ILD组		762.55（452.49，1 193.57）^ab
χ²		6.352^＊