Kim Youlim, Lee Yeon Joo, Cho Young-Jae, Yoon Ho Il, Lee Jae Ho, Lee Choon-Taek, Park Jong Sun
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital.
Tohoku J Exp Med. 2018 Nov;246(3):147-153. doi: 10.1620/tjem.246.147.
Chronic fibrosing interstitial lung disease (ILD)s are characterized by chronic progressive fibrosis of lung which include idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), and connective tissue disease-associated interstitial lung disease (CTD-ILD). IPF is an irreversible fibrotic lung disease which results in respiratory failure. Although NSIP and CTD-ILD can be improved or stable by treatment with corticosteroid or immunosuppressant, some of them progress to fibrotic lung diseases. Aspiration of gastric contents is suggested as an aggravating factor of ILDs. We measured pepsin, a marker of gastric aspiration, in bronchoalveolar lavage (BAL) fluid of chronic fibrosing ILD patients to evaluate the association between BAL fluid pepsin and prognosis of chronic fibrosing ILDs. Patients with chronic fibrosing ILDs, who underwent bronchoscopy between December 2010 and April 2015 were prospectively enrolled. Pepsin levels were measured using a commercial ELISA kit. Clinical characteristics, lung function data, and mortality were analyzed. Fifty-one patients with chronic fibrosing ILDs were enrolled (26 with IPF, 15 with NSIP, and 10 with CTD-ILD). Pepsin levels in BAL fluid were 69.87 ± 74.16 ng/mL in IPF, 110.68 ± 94.93 ng/mL in NSIP, and 101.87 ± 88.44 ng/mL in CTD-ILDs. There were no statistically significant differences in BAL fluid pepsin levels among patients with the different chronic fibrosing ILDs. In multivariate regression analysis, higher BAL pepsin levels were associated with higher mortality (adjusted odds ratio [aOR] = 1.021, p = 0.025). BAL fluid pepsin may be used as a prognostic marker for predicting mortality in chronic fibrosing ILD patients.
慢性纤维化间质性肺疾病（ILD）的特征是肺部慢性进行性纤维化，包括特发性肺纤维化（IPF）、非特异性间质性肺炎（NSIP）和结缔组织病相关间质性肺疾病（CTD-ILD）。IPF是一种不可逆的纤维化性肺病，可导致呼吸衰竭。虽然NSIP和CTD-ILD通过使用皮质类固醇或免疫抑制剂治疗可得到改善或稳定，但其中一些会进展为纤维化性肺病。胃内容物误吸被认为是ILD的一个加重因素。我们检测了慢性纤维化ILD患者支气管肺泡灌洗（BAL）液中胃误吸标志物胃蛋白酶，以评估BAL液胃蛋白酶与慢性纤维化ILD预后之间的关联。前瞻性纳入了2010年12月至2015年4月期间接受支气管镜检查的慢性纤维化ILD患者。使用商用ELISA试剂盒检测胃蛋白酶水平。分析临床特征、肺功能数据和死亡率。纳入了51例慢性纤维化ILD患者（26例IPF、15例NSIP和10例CTD-ILD）。IPF患者BAL液中胃蛋白酶水平为69.87±74.16 ng/mL，NSIP患者为110.68±94.93 ng/mL，CTD-ILD患者为101.87±88.44 ng/mL。不同慢性纤维化ILD患者的BAL液胃蛋白酶水平无统计学显著差异。在多变量回归分析中，较高的BAL胃蛋白酶水平与较高的死亡率相关（调整优势比[aOR]=1.021，p=0.025）。BAL液胃蛋白酶可作为预测慢性纤维化ILD患者死亡率的预后标志物。
