Ogawa Noriyoshi, Shimoyama Kumiko, Kawabata Hiroshi, Masaki Yasufumi, Wano Yuji, Sugai Susumu
Division of Hematology and Immunology, Department of Internal Medicine, Kanazawa Medical University, Kahokugun, Ishikawa.
Ryumachi. 2003 Feb;43(1):19-28.
To elucidate the clinical significance of serum KL-6 and SP-D for the diagnosis and treatment of interstitial lung disease in connective tissue disorders.
139 patients with various connective tissue disorders were subjected for the study, which included 46 cases of rheumatoid arthritis, 43 cases of Sjögren's syndrome, 16 cases of SLE, 10 cases of systemic sclerosis, 9 cases of polymyositis/dermatomyositis, 6 cases of vasculitis syndrome, 5 cases of Behçet's disease and 4 cases of MCTD. Serum levels of KL-6 and SP-D were determined by enzyme-immunoassay. The sensitivity, specificity and accuracy of serum KL-6 and SP-D for the diagnosis of interstitial lung disease were compared with serum LDH. The relationship of serum KL-6 and SP-D levels with high resolution CT (HRCT) of the lung and Gallium scintigraphy findings was analyzed. In some cases, serum levels of the two markers were determined monthly in the course of the disease.
When the serum levels of KL-6 and SP-D were measured simultaneously, the sensitivity to diagnose interstitial lung disease was 67.7%, the specificity was 98.1%, and the accuracy was 91.4%, while those of serum LDH were 45.2%, 88.9%, 79.1% respectively. In the patients with interstitial lung disease, those who had elevated serum levels of both KL-6 and SP-D showed parenchymal collapse opacity-dominant pattern in HRCT. On the other hand, the patients with interstitial lung disease who had normal levels of serum KL-6 and SP-D or had elevation either in KL-6 or SP-D levels showed ground glass opacity-dominant pattern in HRCT. There was no significant correlation between serum marker levels and Gallium scintigraphy findings. When serum KL-6 and SP-D were measured monthly, the levels of both markers changed more specifically and sensitively to the lung disease activity compared with serum LDH.
Serum KL-6 and SP-D are more specific and useful markers for the diagnosis and evaluation of interstitial lung disease compared with serum LDH in connective tissue disorders.
阐明血清KL-6和SP-D在结缔组织病所致间质性肺疾病诊断及治疗中的临床意义。
对139例各种结缔组织病患者进行研究，其中类风湿关节炎46例、干燥综合征43例、系统性红斑狼疮16例、系统性硬化症10例、多发性肌炎/皮肌炎9例、血管炎综合征6例、白塞病5例、混合性结缔组织病4例。采用酶免疫法测定血清KL-6和SP-D水平。将血清KL-6和SP-D诊断间质性肺疾病的敏感性、特异性和准确性与血清乳酸脱氢酶（LDH）进行比较。分析血清KL-6和SP-D水平与肺部高分辨率CT（HRCT）及镓扫描结果的关系。部分病例在病程中每月测定一次这两种标志物的血清水平。
同时检测血清KL-6和SP-D时，诊断间质性肺疾病的敏感性为67.7%，特异性为98.1%，准确性为91.4%，而血清LDH的敏感性、特异性和准确性分别为45.2%、88.9%、79.1%。在间质性肺疾病患者中，血清KL-6和SP-D均升高者HRCT表现为实变萎陷为主型。另一方面，血清KL-6和SP-D水平正常或仅其中一项升高的间质性肺疾病患者HRCT表现为磨玻璃影为主型。血清标志物水平与镓扫描结果无明显相关性。每月测定血清KL-6和SP-D时，与血清LDH相比，这两种标志物的水平对肺部疾病活动的变化更具特异性和敏感性。
在结缔组织病中，与血清LDH相比，血清KL-6和SP-D是诊断和评估间质性肺疾病更具特异性和实用性的标志物。
