He X W, Luo Q Z, Shang Y, Gao Z C
Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China (is working in the Department of Internal Medicine, Xicheng District Zhanlanlu Hospital, Beijing 100044, China).
Zhonghua Yi Xue Za Zhi. 2019 Oct 15;99(38):2976-2981. doi: 10.3760/cma.j.issn.0376-2491.2019.38.003.
To explore the expression and clinical significance of chemokine ligand 18 (CCL18) in Bronchoalveolar Lavage Fluid (BALF) of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). From January 2016 to June 2017, BALF of patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD group), patients with dermatomyositis-associated interstitial lung disease (DM-ILD group), and patients with primary Sjögren syndrome-associated interstitial lung disease (pSS-ILD group) of Peking University People's Hospital were collected. According to the prognosis of each group of patients during hospitalization, they were divided into the discharged and the died. Besides, 30 patients without ILD served as a control group. Levels of CCL18 in BALF of all patients were tested by enzyme linked immunosorbent assay (ELISA). Cells in BALF of RA-ILD group, DM-ILD group and pSS-ILD group were collected and analyzed by absolute different cell counts. Results of high-resolution CT (HRCT) of these three groups were scored. In addition, the area under the curve (AUC) of CCL18 in predicting mortality during hospitalization was calculated. A total of 38 patients with RA-ILD, 54 patients with DM-ILD, and 35 patients with pSS-ILD were enrolled. Levels of CCL18 of those discharged patients of RA-ILD, DM-ILD, and pSS-ILD groups were 8.27(3.62, 14.36), 11.04 (5.86, 17.38), 5.25(2.68, 8.21) μg/L, respectively, which were all significantly higher than that of the control group [2.54(1.26, 3.66) μg/L, all 0.05]. Furthermore, levels of CCL18 of those deceased patients of RA-ILD and DM-ILD groups were 18.28 (13.82, 22.39), 18.81 (16.29, 22.90) μg/L, which were significantly higher than that of the discharged patients of same group (all 0.05). Levels of CCL18 were positively correlated with lymphocyte percentage in BALF of RA-ILD, DM-ILD and pSS-ILD groups (0.4356, 0.4029, 0.3939, respectively, all 0.05). Besides, levels of CCL18 were significantly correlated with HRCT scores of RA-ILD and DM-ILD groups (0.4242, 0.3319, respectively, both 0.05). Areas under the curve (AUCs) of CCL18 to predict mortality during hospitalization of RA-ILD and DM-ILD groups were 0.860, 0.851, respectively. Levels of CCL18 are elevated in BALF of CTD-ILD patients, and may be correlated with the severity and prognosis during hospitalization. CCL18 might be served as an indicator of the severity and prognosis of CTD-ILD.
探讨趋化因子配体18（CCL18）在结缔组织病相关间质性肺病（CTD-ILD）患者支气管肺泡灌洗液（BALF）中的表达及临床意义。收集2016年1月至2017年6月北京大学人民医院类风湿关节炎相关间质性肺病患者（RA-ILD组）、皮肌炎相关间质性肺病患者（DM-ILD组）和原发性干燥综合征相关间质性肺病患者（pSS-ILD组）的BALF。根据每组患者住院期间的预后情况，分为出院组和死亡组。此外，选取30例无ILD的患者作为对照组。采用酶联免疫吸附测定（ELISA）检测所有患者BALF中CCL18水平。收集RA-ILD组、DM-ILD组和pSS-ILD组BALF中的细胞，采用绝对细胞计数法进行分析。对这三组患者的高分辨率CT（HRCT）结果进行评分。此外，计算CCL18预测住院期间死亡率的曲线下面积（AUC）。共纳入38例RA-ILD患者、54例DM-ILD患者和35例pSS-ILD患者。RA-ILD组、DM-ILD组和pSS-ILD组出院患者的CCL18水平分别为8.27（3.62，14.36）、11.04（5.86，17.38）、5.25（2.68，8.21）μg/L，均显著高于对照组[2.54（1.26，3.66）μg/L，均P<0.05]。此外，RA-ILD组和DM-ILD组死亡患者的CCL18水平分别为18.28（13.82，22.39）、18.81（16.29，22.90）μg/L，显著高于同组出院患者（均P<0.05）。RA-ILD组、DM-ILD组和pSS-ILD组BALF中CCL18水平与淋巴细胞百分比呈正相关（分别为0.4356、0.4029、0.3939，均P<0.05）。此外，RA-ILD组和DM-ILD组CCL18水平与HRCT评分显著相关（分别为0.4242、0.3319，均P<0.05）。CCL18预测RA-ILD组和DM-ILD组住院期间死亡率的曲线下面积（AUC）分别为0.860、0.851。CTD-ILD患者BALF中CCL18水平升高，可能与住院期间疾病严重程度及预后相关。CCL18可能作为CTD-ILD严重程度及预后的指标。
