背景:血清标志物KrebsvondenLungen-6(KL-6),表面活性剂蛋白A(SP-A),和表面活性蛋白D(SP-D)已用于诊断,鉴别诊断,间质性肺炎的预后预测。然而,测定血清和支气管肺泡灌洗液(BALF)KL-6、SP-D,和SP-A水平在预测慢性纤维化间质性肺炎(CFIP)预后中,特发性肺纤维化,和特发性非特异性间质性肺炎仍不清楚.我们旨在阐明测量血清和BALFKL-6,SP-A的意义,SP-D水平对CFIP患者预后的预测价值.
方法:在2008年9月至2021年2月期间诊断为CFIP的173例患者中,有39例接受了支气管肺泡灌洗。其中,强迫肺活量(FVC)每年下降≥10%的患者或由于肺功能显著恶化而在接受随访肺功能检查时面临挑战的患者被归类为快速进展组.相反,FVC年下降<10%的个体被归入缓慢进展组.血清和BALFKL-6,SP-D,和SP-A水平,比较两组BALF/血清SP-D和SP-A比值。
结果:在CFIP患者中,BALFSP-D水平(p=0.0111),BALFSP-A水平(p<0.0010),BALF/血清SP-D比值(p=0.0051),而BALF/血清SP-A比值(p<0.0010)在快速组显著低于缓慢组(p<0.0010)。接收器工作特性分析结果证明了诊断CFIP患者的出色性能,与BALFSP-D水平(曲线下面积[AUC],0.7424),BALFSP-A水平(AUC,0.8842),BALF/血清SP-D比值(AUC,0.7673),和BALF/血清SP-A比值(AUC,0.8556)。此外,BALFSP-A水平显示出显著优异的CFIP诊断能力.使用Kaplan-Meier方法进行的生存分析显示,BALFSP-A水平<1500ng/mL且BALF/血清SP-A比率<15.0的患者预后较差。
结论:我们的结果表明,BALFSP-A测量可能有助于预测CFIP患者的预后。
BACKGROUND: The serum markers Krebs von den Lungen-6 (KL-6), surfactant protein A (SP-A), and surfactant protein D (SP-D) have been used for the diagnosis, differential diagnosis, and prognosis prediction of interstitial pneumonia. However, the significance of measuring the serum and bronchoalveolar lavage fluid (BALF) KL-6, SP-D, and SP-A levels in predicting the prognosis of chronic fibrosing interstitial pneumonia (CFIP), idiopathic pulmonary fibrosis, and idiopathic nonspecific interstitial pneumonia remains unclear. We aimed to clarify the significance of measuring the serum and BALF KL-6, SP-A, and SP-D levels in predicting the prognosis of patients with CFIP.
METHODS: Among 173 patients who were diagnosed with CFIP between September 2008 and February 2021, 39 who underwent bronchoalveolar lavage were included in this
study. Among these, patients experiencing an annual decrease in forced vital capacity (FVC) of ≥10% or those facing challenges in undergoing follow-up pulmonary function tests owing to significant deterioration in pulmonary function were categorized as the rapidly progress group. Conversely, individuals with an annual decrease in the FVC of <10% were classified into the slowly progress group. The serum and BALF KL-6, SP-D, and SP-A levels, as well as BALF/serum SP-D and SP-A ratios were compared between the two groups.
RESULTS: Among the patients with CFIP, the BALF SP-D level (p=0.0111), BALF SP-A level (p<0.0010), BALF/serum SP-D ratio (p=0.0051), and BALF/serum SP-A ratio (p<0.0010) were significantly lower in the rapidly than in the slowly progress group (p<0.0010). The receiver operating characteristics analysis results demonstrated excellent performance for diagnosing patients with CFIP, with the BALF SP-D level (area under the curve [AUC], 0.7424), BALF SP-A level (AUC, 0.8842), BALF/serum SP-D ratio (AUC, 0.7673), and BALF/serum SP-A ratio (AUC, 0.8556). Moreover, the BALF SP-A level showed a notably superior CFIP diagnostic capability. Survival analysis using the Kaplan-Meier method revealed that patients with a BALF SP-A level of <1500 ng/mL and BALF/serum SP-A ratio of <15.0 had poor prognoses.
CONCLUSIONS: Our results suggest that BALF SP-A measurement may be useful for predicting the prognosis in patients with CFIP.