Shimizu Hiroshige, Sakamoto Susumu, Okamoto Masaki, Isshiki Takuma, Ono Junya, Shimizu Shigeki, Hoshino Tomoaki, Izuhara Kenji, Homma Sakae
Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan.
Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan.
Ann Transl Med. 2021 May;9(9):739. doi: 10.21037/atm-21-414.
The associations of serum monomeric periostin (M-PN) level and serial change in M-PN with acute exacerbation of chronic fibrosing interstitial pneumonia (AE-FIP) are unclear.
We prospectively measured serum M-PN level from onset of AE to day 14 in 37 patients with AE-FIP and evaluated its association with outcome. To determine localization of periostin expression, immunohistochemical staining of pathological lung tissue from autopsy cases of AE-IPF was evaluated.
Data from 37 AE-FIP patients (28 men; age 73.9±7.8 years) were analyzed. With healthy controls as reference, serum M-PN level was significantly higher in patients with AE-FIP (P=0.02) but not in those with stable idiopathic pulmonary fibrosis (P=1.00). M-PN was significantly lower on day 7 than at AE-FIP onset in survivors [14.6±5.8 9.3±2.8 ng/mL (onset to day 7: P<0.001)] but not in non-survivors [14.6±5.1 13.2±5.1 ng/mL (onset to day 7: P=0.07)]. In analysis using a cut-off value for serial change in M-PN (ΔM-PN), 3-month survival was 92.3% in the ΔM-PN decrease group and 36% in the ΔM-PN increase group (P=0.002). In multivariate analysis, 3-month survival tended to be associated with high ΔM-PN (OR: 12.4, 95% CI: 0.82-187.9, P=0.069).
Serial change in serum M-PN level may be a prognostic indicator of AE-FIP.
血清单体骨膜蛋白（M-PN）水平以及M-PN的系列变化与慢性纤维化间质性肺炎急性加重（AE-FIP）之间的关联尚不清楚。
我们前瞻性地测量了37例AE-FIP患者从AE发作至第14天的血清M-PN水平，并评估其与预后的关联。为确定骨膜蛋白表达的定位，对AE-IPF尸检病例的病理肺组织进行了免疫组织化学染色评估。
分析了37例AE-FIP患者（28例男性；年龄73.9±7.8岁）的数据。以健康对照为参照，AE-FIP患者的血清M-PN水平显著更高（P=0.02），但稳定期特发性肺纤维化患者的血清M-PN水平无显著差异（P=1.00）。幸存者在第7天时的M-PN显著低于AE-FIP发作时[14.6±5.8对9.3±2.8 ng/mL（发作至第7天：P<0.001）]，而非幸存者则无此差异[14.6±5.1对13.2±5.1 ng/mL（发作至第7天：P=0.07）]。在使用M-PN系列变化的临界值（ΔM-PN）进行的分析中，ΔM-PN降低组的3个月生存率为92.3%，ΔM-PN升高组为36%（P=0.002）。在多变量分析中，3个月生存率倾向于与高ΔM-PN相关（比值比：12.4，95%置信区间：0.82-187.9，P=0.069）。
血清M-PN水平的系列变化可能是AE-FIP的一个预后指标。
