Department of Pulmonology, Centre for Interstitial Lung Diseases, St. Antonius Hospital Nieuwegein, Post Box 2500, 3435 CM, Nieuwegein, The Netherlands.
Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, The Netherlands.
Lung. 2020 Apr;198(2):385-393. doi: 10.1007/s00408-020-00330-9. Epub 2020 Jan 28.
Hypersensitivity pneumonitis (HP) is an interstitial lung disease with a heterogeneous course of disease and treatment response. Cancer antigen 15-3 (CA 15-3), part of mucin 1, is believed to reflect epithelial cell injury and lung permeability and could be a potential biomarker for treatment response in HP.
To assess the value of CA 15-3 as a predictive biomarker in non-fibrotic and fibrotic HP during immunosuppressive therapy.
Serum levels of CA 15-3 and pulmonary function tests (PFTs) were retrospectively retrieved from 48 HP patients treated with prednisone or cyclophosphamide at initiation of therapy (baseline), after 3 and 6 months. Pearson's correlation coefficient was computed to assess correlations between change in serum levels and PFT. Survival was evaluated using Kaplan-Meier curves.
After 6 months of immunosuppressive therapy CA 15-3 levels decreased significantly compared to baseline (p = 0.001). Change in CA 15-3 after 6 months correlated with FVC change (r = - 0.469; p = 0.001). Correlations with FVC change were observed in prednisone-treated HP (r = - 0.514; p = 0.005) and fibrotic HP (r = - 0.417; p = 0.007). Three-month CA 15-3 change correlated with 6-month FVC change (r = - 0.599; p < 0.001). CA 15-3 declines of at least 7.9% after 6 months were associated with increased survival compared to minor CA 15-3 changes (HR 0.34; p = 0.020).
Serum CA 15-3 correlates with PFT during 6 months of immunosuppressive therapy in HP. Interestingly, early CA 15-3 changes could predict future PFT. Furthermore, a decrease in CA 15-3 is related to longer survival. Therefore, serum CA 15-3 is a promising biomarker for implementation in HP care.
过敏性肺炎（HP）是一种间质性肺疾病，其疾病过程和治疗反应存在异质性。癌抗原 15-3（CA 15-3）是黏蛋白 1 的一部分，被认为反映了上皮细胞损伤和肺通透性，可能是 HP 治疗反应的潜在生物标志物。
评估 CA 15-3 作为非纤维化和纤维化 HP 患者在免疫抑制治疗期间的预测生物标志物的价值。
回顾性检索 48 例接受泼尼松或环磷酰胺治疗的 HP 患者在治疗开始时（基线）、治疗后 3 个月和 6 个月的血清 CA 15-3 水平和肺功能检查（PFT）。计算 Pearson 相关系数以评估血清水平变化与 PFT 之间的相关性。使用 Kaplan-Meier 曲线评估生存情况。
免疫抑制治疗 6 个月后，CA 15-3 水平与基线相比显著降低（p = 0.001）。6 个月时 CA 15-3 的变化与 FVC 的变化相关（r = - 0.469；p = 0.001）。在接受泼尼松治疗的 HP（r = - 0.514；p = 0.005）和纤维化 HP（r = - 0.417；p = 0.007）中观察到与 FVC 变化的相关性。3 个月时 CA 15-3 的变化与 6 个月时 FVC 的变化相关（r = - 0.599；p < 0.001）。与 CA 15-3 变化较小相比，6 个月后 CA 15-3 下降至少 7.9%与生存率增加相关（HR 0.34；p = 0.020）。
在 HP 患者免疫抑制治疗的 6 个月期间，血清 CA 15-3 与 PFT 相关。有趣的是，早期 CA 15-3 变化可预测未来的 PFT。此外，CA 15-3 的降低与更长的生存时间相关。因此，血清 CA 15-3 是一种很有前途的生物标志物，可用于 HP 的治疗。
