KL-6联合肺功能在多发性肌炎/皮肌炎合并间质性肺疾病中的应用价值_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

刘媛媛 , 李艳菊 , 马凤莲 , 陈旭 , 陈曦 , 严晓旭 , 张明珠 , 谢静 , 杨慧 ,  郭东更

宁夏回族自治区人民医院宁夏医科大学附属自治区人民医院风湿免疫科宁夏回族自治区精准医学重点实验室（宁夏银川 750001）;

Corresponding author：

郭东更, Email: guodonggeng@126.com

Keywords：

KL-6; 肺功能; 间质性肺疾病; 多发性肌炎; 皮肌炎

DOI：

10.7507/1671-6205.202306018

Video：

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目的探讨血清KL-6和肺功能检测在多发性肌炎（polymyositis，PM）/皮肌炎（dermatomyositis，DM）合并间质性肺疾病（interstitial lung disease，ILD）中的临床应用价值。方法采用回顾性分析，纳入初发PM/DM患者（n=64）临床资料，分为间质肺组（n=40）和无间质肺组（n=44），另选健康对照组40例，比较三组患者血清KL-6水平及肺功能在两组的差异并分析其在PM/DM-ILD组中的应用价值。结果间质肺组患者KL-6水平明显高于无间质肺组（P<0.01）；间质肺组患者VC%pred、MVV%pred、FEV₁%pred、D_LCO%pred、D_LCO/VA%pred、TLC%pred均低于无间质肺组（P均<0.05）；ROC曲线分析得出PM/DM患者中血清KL-6诊断ILD敏感性为84%，特异性为87.5%，D_LCO%pred诊断ILD的敏感性为97.7%，特异性为57.5%，而二者联合检测敏感性为90.5%，特异性为82.5%；间质肺组血清KL-6与VC%pred、MVV%pred、FVC%pred、FEV₁%pred、D_LCO%pred成反比，与FEV₁/FVC%pred成正比（P均<0.05）；PM/DM发生ILD的危险因素：AST降低、KL-6升高及D_LCO%pred降低。结论 PM/DM患者联合检测血清KL-6和肺弥散功能可提高ILD诊断效能，KL-6和肺功能可能预测ILD的发生及疾病活动度，可指导临床。

Citation： 刘媛媛, 李艳菊, 马凤莲, 陈旭, 陈曦, 严晓旭, 张明珠, 谢静, 杨慧, 郭东更. KL-6联合肺功能在多发性肌炎/皮肌炎合并间质性肺疾病中的应用价值. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(12): 878-883. doi: 10.7507/1671-6205.202306018 Copy

1.	Kliment CR, Englert JM, Gochuico BR, et al. Oxidative stress alters syndecan-1 distribution in lungs with pulmonary fibrosis. J Biol Chem, 2009, 284(6): 3537-45.
2.	史洪博, 卡德力亚, 赵丹. 抗Jo-1抗体、抗SSA/Ro52抗体阳性的多发性肌炎/皮肌炎临床特征分析. 检验医学与临床, 2021, 18(13): 1879-1882.
3.	刘晓阳, 戴丽, 程洋. 多发性肌炎和皮肌炎相关间质性肺疾病的临床特征分析. 北京医学, 2022, 44(2): 108-113.
4.	Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med, 1975, 292(7): 344-347.
5.	Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2013, 188(6): 733-748.
6.	Kohno N, Kyoizumi S, Awaya Y, et al. New serum indicator of interstitial pneumonitis activity. Sialylated carbohydrate antigen KL-6. Chest, 1989, 96(1): 68-73.
7.	Nakajima H, Harigai M, Hara M, et al. KL-6 as a novel serum marker for interstitial pneumonia associated with collagen diseases. J Rheumatol, 2000, 27(5): 1164-1170.
8.	He QR, Tang YF, Huang J, et al. The value of KL-6 in the diagnosis and assessment of interstitial lung disease. Am J Transl Res, 2021, 13(8): 9216-9223.
9.	侯俊, 闫淯淳, 苏改秀, 等. 抗黑色素瘤分化相关基因蛋白5抗体与幼年皮肌炎间质性肺病严重程度的关系. 中华医学杂志, 2021, 101(33): 2606-2610.
10.	Hu C, Wu C, Yang E, et al. Serum KL-6 is associated with the severity of interstitial lung disease in Chinese patients with polymyositis and dermatomyositis. Clin Rheumatol, 2019, 38(8): 2181-2187.
11.	刘玉梦, 许爱国, 赵玉苗, 等. 血清KL-6对多发性肌炎/皮肌炎合并肺部疾病的临床价值. 中国实用医刊, 2017, 44(10): 10-12.
12.	Hanaoka M, Katsumata Y, Kawasumi H, et al. KL-6 is a long-term disease-activity biomarker for interstitial lung disease associated with polymyositis/dermatomyositis, but is not a short-term disease-activity biomarker. Mod Rheumatol, 2019, 29(4): 625-632.
13.	吴雪, 武丽君, 罗采南等. 涎液化糖链抗原-6在结缔组织病相关间质性肺病诊断中的应用价值. 中华医学杂志, 2019, 99(40): 3172-3175.
14.	Lee JS, Lee EY, Ha YJ, et al. Serum KL-6 levels reflect the severity of interstitial lung disease associated with connective tissue disease. Arthritis Res Ther, 2019, 21(1): 58.
15.	Rai M, Parthasarathi A, Beeraka NM, et al. Circulatory Serum Krebs von Den Lungen-6 and Surfactant Protein-D Concentrations Predict Interstitial Lung Disease Progression and Mortality. Cells, 2023, 12(9): 1281.
16.	孙迪, 程哲, 蒋天赐, 等. 肺功能和KL-6在抗合成酶综合征相关间质性肺疾病与特发性肺纤维化中的特点及临床意义. 中华医学杂志, 2020, 100(10): 748-752.
17.	Li T, Tang ZY, Zhang QB, et al. Clinical Characteristics and Risk Factors of Polymyositis and Dermatomyositis Combined with Interstitial Lung Disease in Patients Residing in the Northeast Sichuan Province of China. Curr Rheumatol Rev, 2023, 19(4): 455-462.

1. Kliment CR, Englert JM, Gochuico BR, et al. Oxidative stress alters syndecan-1 distribution in lungs with pulmonary fibrosis. J Biol Chem, 2009, 284(6): 3537-45.
2. 史洪博, 卡德力亚, 赵丹. 抗Jo-1抗体、抗SSA/Ro52抗体阳性的多发性肌炎/皮肌炎临床特征分析. 检验医学与临床, 2021, 18(13): 1879-1882.
3. 刘晓阳, 戴丽, 程洋. 多发性肌炎和皮肌炎相关间质性肺疾病的临床特征分析. 北京医学, 2022, 44(2): 108-113.
4. Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med, 1975, 292(7): 344-347.
5. Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2013, 188(6): 733-748.
6. Kohno N, Kyoizumi S, Awaya Y, et al. New serum indicator of interstitial pneumonitis activity. Sialylated carbohydrate antigen KL-6. Chest, 1989, 96(1): 68-73.
7. Nakajima H, Harigai M, Hara M, et al. KL-6 as a novel serum marker for interstitial pneumonia associated with collagen diseases. J Rheumatol, 2000, 27(5): 1164-1170.
8. He QR, Tang YF, Huang J, et al. The value of KL-6 in the diagnosis and assessment of interstitial lung disease. Am J Transl Res, 2021, 13(8): 9216-9223.
9. 侯俊, 闫淯淳, 苏改秀, 等. 抗黑色素瘤分化相关基因蛋白5抗体与幼年皮肌炎间质性肺病严重程度的关系. 中华医学杂志, 2021, 101(33): 2606-2610.
10. Hu C, Wu C, Yang E, et al. Serum KL-6 is associated with the severity of interstitial lung disease in Chinese patients with polymyositis and dermatomyositis. Clin Rheumatol, 2019, 38(8): 2181-2187.
11. 刘玉梦, 许爱国, 赵玉苗, 等. 血清KL-6对多发性肌炎/皮肌炎合并肺部疾病的临床价值. 中国实用医刊, 2017, 44(10): 10-12.
12. Hanaoka M, Katsumata Y, Kawasumi H, et al. KL-6 is a long-term disease-activity biomarker for interstitial lung disease associated with polymyositis/dermatomyositis, but is not a short-term disease-activity biomarker. Mod Rheumatol, 2019, 29(4): 625-632.
13. 吴雪, 武丽君, 罗采南等. 涎液化糖链抗原-6在结缔组织病相关间质性肺病诊断中的应用价值. 中华医学杂志, 2019, 99(40): 3172-3175.
14. Lee JS, Lee EY, Ha YJ, et al. Serum KL-6 levels reflect the severity of interstitial lung disease associated with connective tissue disease. Arthritis Res Ther, 2019, 21(1): 58.
15. Rai M, Parthasarathi A, Beeraka NM, et al. Circulatory Serum Krebs von Den Lungen-6 and Surfactant Protein-D Concentrations Predict Interstitial Lung Disease Progression and Mortality. Cells, 2023, 12(9): 1281.
16. 孙迪, 程哲, 蒋天赐, 等. 肺功能和KL-6在抗合成酶综合征相关间质性肺疾病与特发性肺纤维化中的特点及临床意义. 中华医学杂志, 2020, 100(10): 748-752.
17. Li T, Tang ZY, Zhang QB, et al. Clinical Characteristics and Risk Factors of Polymyositis and Dermatomyositis Combined with Interstitial Lung Disease in Patients Residing in the Northeast Sichuan Province of China. Curr Rheumatol Rev, 2023, 19(4): 455-462.

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KL-6联合肺功能在多发性肌炎/皮肌炎合并间质性肺疾病中的应用价值

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