背景:全身性自身免疫性风湿性疾病(SARD)患者的间质性肺病(ILD)的自然病程差异很大,并且与相当高的发病率和死亡率有关。因此,有效的筛查对早期发现SARD-ILD至关重要。与粘蛋白1,KrebsvondenLungen-6(KL-6)和碳水化合物抗原15-3(CA15-3)相关的生物标志物,在各种ILD中增加。这项研究旨在评估血清生物标志物CA15-3作为新诊断为SARD的患者ILD的潜在筛查工具的诊断准确性。
方法:作为单中心横断面研究进行,这项研究包括根据算法连续检查ILD的新诊断SARD患者.所有纳入患者均接受胸部高分辨率CT扫描(HRCT),测量血清CA15-3,KL-6和乳酸脱氢酶(LDH)的水平,并与可能存在ILD相关的其他变量相关联。
结果:血清生物标志物水平,特别是CA15-3和LDH,在ILD阳性患者中显著更高(两者P<0.001)。在较高的FVC值和较低的CA15-3水平之间观察到反比关系(Rho=-0.291,P=0.007)。同样,较高的DLCO值与较低的CA15-3水平相关(Rho=-0.317,P=0.003).我们的研究结果表明,升高的CA15-3水平与较高的KL-6(Rho=0.268,P=0.01)和LDH(Rho=0.227,P=0.04)呈正相关。截止值为24U/mL时,CA15-3显示出最高的灵敏度和特异度(AUC=0.807,特异度=95.7%,灵敏度=71.1%)。CA15-3是HRCT阳性发现的最重要预测因子,对83%的病例进行准确分类。
结论:这些结果表明,CA15-3有望作为常规临床实践中筛查SARD患者ILD的有价值的血清生物标志物。
BACKGROUND: The natural course of interstitial lung disease (ILD) in patients with systemic autoimmune rheumatic diseases (SARD) varies significantly and is linked to considerable morbidity and mortality. Therefore, effective screening is crucial for early detection of SARD-ILD. Biomarkers associated with mucin 1, Krebs von den Lungen-6 (KL-6) and carbohydrate antigen 15-3 (CA 15-3), are increased in various ILD. This study aimed to assess the diagnostic accuracy of the serum biomarker CA 15-3 as a potential screening tool for ILD in patients newly diagnosed with SARD.
METHODS: Conducted as a single-center cross-sectional study, the research included newly diagnosed SARD patients consecutively examined for ILD according to the algorithm. All included patients underwent chest high-resolution CT scans (HRCT), and serum levels of CA 15-3, KL-6, and lactate dehydrogenase (LDH) were measured and correlated with other variables associated with possible ILD presence.
RESULTS: Serum biomarker levels, specifically CA 15-3 and LDH, are significantly higher in ILD-positive patients (P<0.001 for both). An inverse relationship is observed between higher FVC values and lower CA 15-3 levels (Rho=-0.291, P=0.007). Similarly, higher DLCO values are associated with lower CA 15-3 levels (Rho=-0.317, P=0.003). Our findings revealed that elevated CA 15-3 levels are positively correlated with higher levels of KL-6 (Rho=0.268, P=0.01) and LDH (Rho=0.227, P=0.04). With a cut-off value of 24 U/mL, CA 15-3 showed the highest sensitivity and specificity (AUC=0.807, specificity=95.7%, sensitivity=71.1%). CA 15-3 emerged as the most significant predictor of a positive HRCT finding, accurately classifying 83% of cases.
CONCLUSIONS: These results suggest that CA 15-3 shows promise as a valuable serum biomarker for screening SARD patients for ILD in routine clinical practice.