Janssen Rob, Sato Hiroe, Grutters Jan C, Bernard Alfred, van Velzen-Blad Heleen, du Bois Roland M, van den Bosch Jules M M
Heart Lung Center Utrecht, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands.
Chest. 2003 Dec;124(6):2119-25. doi: 10.1378/chest.124.6.2119.
To determine the discriminative value of serum Clara cell 16 (CC16), KL-6, and surfactant protein (SP)-D as markers of interstitial lung diseases, and their ability to reflect pulmonary disease severity and prognosis in sarcoidosis.
Seventy-nine patients with sarcoidosis and 38 control subjects.
Serum CC16, KL-6, and SP-D concentrations at disease presentation were measured. Pulmonary function tests and chest radiographs were analyzed at presentation and 2-year follow-up.
All markers co-correlated, and a significant difference was found between CC16, KL-6 (Krebs von den Lungen-6), and SP-D levels in patients with sarcoidosis and control subjects (p < 0.0001). Receiver operating characteristic curve analysis revealed largest area under the curve for KL-6. Significantly higher levels of CC16 and KL-6 were found in patients with parenchymal infiltration (stage II, III) compared to patients without parenchymal infiltration (stage I). In concordance, CC16 and KL-6 levels inversely correlated with diffusion capacity and total lung capacity, and KL-6 also with inspiratory vital capacity. Moreover, higher KL-6 levels were weakly but significantly associated with persistence or progression of parenchymal infiltrates at 2-year follow-up.
In this study, KL-6 appears to be the best discriminative marker in differentiating patients with sarcoidosis from healthy control subjects; however, as it is not a specific marker for this condition, this quality is unlikely to be useful as a diagnostic tool. Both CC16 and KL-6 may be of value in reflecting disease severity, and KL-6 tends to associate with pulmonary disease outcome.
确定血清克拉拉细胞16（CC16）、KL-6和表面活性蛋白（SP）-D作为间质性肺疾病标志物的鉴别价值，以及它们反映结节病患者肺部疾病严重程度和预后的能力。
79例结节病患者和38例对照者。
在疾病初发时测定血清CC16、KL-6和SP-D浓度。在初发时和2年随访时分析肺功能测试和胸部X线片。
所有标志物均呈共同相关，结节病患者与对照者的CC16、KL-6（克雷布斯肺肿瘤-6）和SP-D水平存在显著差异（p<0.0001）。受试者工作特征曲线分析显示KL-6的曲线下面积最大。与无实质浸润（I期）的患者相比，有实质浸润（II期、III期）的患者CC16和KL-6水平显著更高。与此一致的是，CC16和KL-6水平与弥散能力和肺总量呈负相关，KL-6也与吸气肺活量呈负相关。此外，在2年随访时，较高的KL-6水平与实质浸润的持续或进展呈弱但显著的相关性。
在本研究中，KL-6似乎是区分结节病患者与健康对照者的最佳鉴别标志物；然而，由于它不是这种疾病的特异性标志物，这种特性不太可能作为诊断工具。CC16和KL-6在反映疾病严重程度方面可能都有价值，且KL-6倾向于与肺部疾病的转归相关。
