Miyazaki Eishi, Nureki Shin-ichi, Ono Emiko, Ando Masaru, Matsuno Osamu, Fukami Tetsujiro, Ueno Takuya, Kumamoto Toshihide
Division of Pulmonary Disease, Department of Brain and Nerve Science, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.
Chest. 2007 Jun;131(6):1726-34. doi: 10.1378/chest.06-2596.
The presentation of acute eosinophilic pneumonia (AEP) closely resembles that of acute lung injury (ALI)/ARDS, including its idiopathic form, acute interstitial pneumonia (AIP). AEP usually lacks peripheral eosinophilia at the acute phase; therefore, the establishment of serum biomarkers for AEP would be clinically useful.
We measured the levels of thymus- and activation-regulated chemokine (TARC)/CCL17, eotaxin/CCL11, KL-6, and surfactant protein-D (SP-D) in serum for patients with acute parenchymal lung diseases including AEP (n = 17), AIP (n = 13), pneumonia-associated ALI/ARDS (n = 12), and alveolar hemorrhage (n = 7). To evaluate diagnostic ability, each marker was estimated by measuring the area under the receiver operating characteristic curve (AUC).
Serum TARC/CCL17 levels of AEP patients were much higher than those of patients in other disease groups. More importantly, high circulating TARC/CCL17 levels were observed in AEP even at acute phase when peripheral eosinophilia was absent. TARC/CCL17 showed the largest AUC, and the TARC/CCL17 levels with cutoff points from 6,259 to 7,039 pg/mL discriminated AEP from other syndromes with sensitivity and specificity of 100%. The KL-6 level was low in most patients with AEP, and the sensitivity was 81.6% in cutoff with 100% specificity. The AUC for eotaxin/CCL11 and SP-D was small, with values of 0.73 (95% confidence interval [CI], 0.60 to 0.86) and 0.53 (95% CI, 0.31 to 0.64), respectively.
This study indicates that the measurement of circulating TARC/CCL17 and KL-6 is useful for discriminating AEP from other causes of ALI.
急性嗜酸性粒细胞性肺炎（AEP）的表现与急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）极为相似，包括其特发性形式急性间质性肺炎（AIP）。AEP在急性期通常缺乏外周血嗜酸性粒细胞增多；因此，建立AEP的血清生物标志物在临床上将很有用。
我们检测了包括AEP（n = 17）、AIP（n = 13）、肺炎相关ALI/ARDS（n = 12）和肺泡出血（n = 7）在内的急性实质性肺疾病患者血清中胸腺和活化调节趋化因子（TARC）/CCL17、嗜酸性粒细胞趋化蛋白/CCL11、KL-6和表面活性蛋白-D（SP-D）的水平。为评估诊断能力，通过测量受试者操作特征曲线（AUC）下的面积对每个标志物进行评估。
AEP患者的血清TARC/CCL17水平远高于其他疾病组的患者。更重要的是，即使在急性期外周血嗜酸性粒细胞未增多时，AEP患者也观察到循环TARC/CCL17水平升高。TARC/CCL17的AUC最大，TARC/CCL17水平在6259至7039 pg/mL的截断点可将AEP与其他综合征区分开来，敏感性和特异性均为100%。大多数AEP患者的KL-6水平较低，在特异性为100%的截断值时敏感性为81.6%。嗜酸性粒细胞趋化蛋白/CCL11和SP-D的AUC较小，分别为0.73（95%置信区间[CI]，0.60至0.86）和0.53（95%CI，0.31至0.64）。
本研究表明，检测循环TARC/CCL17和KL-6有助于将AEP与ALI的其他病因区分开来。
