丙型肝炎病毒相关慢性肝病病例中，间质性肺炎标志物KL-6的临床意义。

Clinical significance of KL-6, a marker of interstitial pneumonia, in cases of HCV-associated chronic liver disease.

作者信息

Suzuki Kazutomo, Takada Hiroshi, Oka Shigeki, Kanouzawa Satoshi, Iimuro Mamoru, Kitazumi Yoshinori, Arima Takeshi, Ohyama Rie, Kuwayama Hajime

机构信息

Department of Gastroenterology and Hepatology, University Hospital at Koshigaya Dokkyo University School of Medicine, Koshigaya, Saitama.

出版信息

Intern Med. 2003 Aug;42(8):650-4. doi: 10.2169/internalmedicine.42.650.

DOI:10.2169/internalmedicine.42.650

PMID:12924486

Abstract

OBJECTIVE

Various antiviral therapies, including interferon therapy, are being conducted to treat chronic hepatitis C and suppress the onset of hepatocellular carcinoma. However, interstitial pneumonia is beginning to be recognized as one of the adverse reactions of this therapy, and is one of the complications associated with chronic hepatitis. Therefore, we measured the level of KL-6, an interstitial pneumonia marker, in patients with HCV-associated chronic disease, and then determined the possibility of utilizing serum KL-6 as a predictive factor for interstitial pneumonia and the clinical significance of KL-6 in HCV-associated chronic disease.

SUBJECTS AND METHODS

The subjects were 308 patients who were diagnosed with chronic liver disease through biochemical blood tests and abdominal diagnostic imaging. All patients tested positive for either the HCV antibody or HCV-RNA, and those who were suspected of having autoimmune hepatitis were excluded. One hundred eighty-five patients had chronic hepatitis (average age: 56 +/- 14 years), while 123 patients had liver cirrhosis (average age: 64 +/- 9 years). The purpose of the present study was explained to every subject, and informed consent was obtained.

RESULTS

The mean KL-6 level for chronic hepatitis patients without interstitial pneumonia was 283.5 +/- 131.4 U/ml, while that for cirrhotic patients without interstitial pneumonia was significantly higher, at 377.6 +/- 212.1 U/ml (p<0.0001). In addition, with a cut-off value of 500 U/ml, the ratio of high KL-6 for the chronic hepatitis patients was 5.41% (10/185), while that for the cirrhotic patients was significantly higher, at 20.33% (25/123) (p<0.0001). Furthermore, the mean KL-6 level for patients with a serum hyaluronic acid level of less than 100 ng/ml was 258.4 +/- 124.6 U/ml, while that for patients with a serum hyaluronic acid level of 100 ng/ml or above was significantly higher, at 381.0 +/- 197.3 U/ml (p<0.0001).

CONCLUSION

Although KL-6 is a marker of interstitial pneumonia, the results of the present study suggest that, in HCV-associated chronic disease, this marker reflects hepatic fibrosis better than pulmonary fibrosis.

摘要

目的

正在开展包括干扰素治疗在内的多种抗病毒疗法来治疗慢性丙型肝炎并抑制肝细胞癌的发生。然而，间质性肺炎正开始被认为是这种疗法的不良反应之一，并且是与慢性肝炎相关的并发症之一。因此，我们检测了丙型肝炎病毒（HCV）相关慢性病患者中间质性肺炎标志物KL-6的水平，进而确定利用血清KL-6作为间质性肺炎预测因子的可能性以及KL-6在HCV相关慢性病中的临床意义。

对象与方法

对象为308例通过生化血液检查和腹部诊断成像被诊断为慢性肝病的患者。所有患者的HCV抗体或HCV-RNA检测均呈阳性，排除疑似自身免疫性肝炎的患者。185例患者患有慢性肝炎（平均年龄：56±14岁），123例患者患有肝硬化（平均年龄：64±9岁）。向每位受试者解释了本研究的目的，并获得了知情同意。

结果

无间质性肺炎的慢性肝炎患者的平均KL-6水平为283.5±131.4 U/ml，而无间质性肺炎的肝硬化患者的平均KL-6水平显著更高，为377.6±212.1 U/ml（p<0.0001）。此外，以500 U/ml为临界值，慢性肝炎患者中KL-6水平高的比例为5.41%（10/185），而肝硬化患者的这一比例显著更高，为20.33%（25/123）（p<0.0001）。此外，血清透明质酸水平低于100 ng/ml的患者的平均KL-6水平为258.4±124.6 U/ml，而血清透明质酸水平为100 ng/ml或更高的患者的平均KL-6水平显著更高，为381.0±197.3 U/ml（p<0.0001）。