Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.
PLoS One. 2020 Dec 17;15(12):e0244114. doi: 10.1371/journal.pone.0244114. eCollection 2020.
Disease progression (DP) in interstitial lung disease (ILD) is variable and difficult to predict. In previous reports, serum Krebs von den Lungen-6 (KL-6) was suggested to be useful in diagnosing and predicting survival in ILD. The aim of our study was to investigate the usefulness of serum KL-6 as a predictor of DP in ILD. Clinical data of 199 patients with ILD (idiopathic pulmonary fibrosis: 22.8%) were prospectively collected and serum KL-6 levels were measured. DP was defined as a relative decline in forced vital capacity (FVC) ≥ 10%, acute exacerbation, or death during follow-up. The median follow-up period was 11.1 months. The mean age of the subjects was 62.2 years, and 59.8% were male. DP occurred in 21.6% of patients. The progressed group showed lower FVC, lower diffusing capacity for carbon monoxide, lower the minimum oxygen saturation during the 6-minute walk test, higher fibrosis scores on high-resolution computed tomography, and higher KL-6 levels (826.3 vs. 629.0 U/mL; p < 0.001) than those of the non-progressed group. In receiver operating characteristic curve analysis, serum KL-6 levels were a significant predictor of DP in ILD (area under the curve = 0.629, p = 0.009, and the optimal cut-off level was 811 U/mL). In multivariable Cox analysis, high serum KL-6 levels (≥ 800 U/mL) were only independently associated with DP in ILD (HR 2.689, 95% CI 1.445-5.004, P = 0.002). Serum KL-6 levels might be useful to predict DP in patients with ILD.
肺纤维化（IPF）是特发性间质性肺炎（IIP）的一种组织学类型，其疾病进展（DP）是可变的，难以预测。在以前的报告中，血清 Krebs von den Lungen-6（KL-6）被认为对诊断和预测 IIP 患者的生存率有用。本研究旨在探讨血清 KL-6 作为 IIP 患者 DP 预测因子的作用。前瞻性收集了 199 例 IIP 患者（特发性肺纤维化：22.8%）的临床数据，并检测了血清 KL-6 水平。DP 定义为随访期间用力肺活量（FVC）相对下降≥10%、急性加重或死亡。中位随访时间为 11.1 个月。受试者的平均年龄为 62.2 岁，59.8%为男性。21.6%的患者发生 DP。进展组的 FVC、一氧化碳弥散量、6 分钟步行试验时的最低氧饱和度、高分辨率计算机断层扫描的纤维化评分和 KL-6 水平（826.3 vs. 629.0 U/mL；p < 0.001）均低于未进展组。在受试者工作特征曲线分析中，血清 KL-6 水平是 IIP 患者 DP 的显著预测因子（曲线下面积=0.629，p=0.009，最佳截断值为 811 U/mL）。在多变量 Cox 分析中，高血清 KL-6 水平（≥800 U/mL）是 IIP 患者 DP 的唯一独立预测因子（HR 2.689，95%CI 1.445-5.004，P=0.002）。血清 KL-6 水平可能有助于预测 IIP 患者的 DP。
