Department of Internal Medicine, General Hospital Zadar, Boze Pericica 5, Zadar, 23000, Croatia.
University of Split School of Medicine, Split, Croatia.
Rheumatol Int. 2024 Oct;44(10):2017-2025. doi: 10.1007/s00296-024-05694-2. Epub 2024 Aug 24.
The natural course of interstitial lung disease (ILD) in patients with systemic autoimmune rheumatic diseases (SARD) varies significantly and is linked to considerable morbidity and mortality. Therefore, effective screening is crucial for early detection of SARD-ILD. Biomarkers associated with mucin 1, Krebs von den Lungen-6 (KL-6) and carbohydrate antigen 15-3 (CA 15-3), are increased in various ILD. This study aimed to assess the diagnostic accuracy of the serum biomarker CA 15-3 as a potential screening tool for ILD in patients newly diagnosed with SARD.
Conducted as a single-center cross-sectional study, the research included newly diagnosed SARD patients consecutively examined for ILD according to the algorithm. All included patients underwent chest high-resolution CT scans (HRCT), and serum levels of CA 15-3, KL-6, and lactate dehydrogenase (LDH) were measured and correlated with other variables associated with possible ILD presence.
Serum biomarker levels, specifically CA 15-3 and LDH, are significantly higher in ILD-positive patients (P<0.001 for both). An inverse relationship is observed between higher FVC values and lower CA 15-3 levels (Rho=-0.291, P=0.007). Similarly, higher DLCO values are associated with lower CA 15-3 levels (Rho=-0.317, P=0.003). Our findings revealed that elevated CA 15-3 levels are positively correlated with higher levels of KL-6 (Rho=0.268, P=0.01) and LDH (Rho=0.227, P=0.04). With a cut-off value of 24 U/mL, CA 15-3 showed the highest sensitivity and specificity (AUC=0.807, specificity=95.7%, sensitivity=71.1%). CA 15-3 emerged as the most significant predictor of a positive HRCT finding, accurately classifying 83% of cases.
These results suggest that CA 15-3 shows promise as a valuable serum biomarker for screening SARD patients for ILD in routine clinical practice.
系统性自身免疫性风湿病（SARD）患者的间质性肺病（ILD）自然病程差异很大，与相当高的发病率和死亡率相关。因此，有效的筛查对于早期发现 SARD-ILD 至关重要。与各种ILD 相关的黏蛋白 1、KL-6（Krebs von den Lungen-6）和 CA 15-3（碳水化合物抗原 15-3）等生物标志物均升高。本研究旨在评估血清生物标志物 CA 15-3 作为一种新诊断为 SARD 患者ILD 潜在筛查工具的诊断准确性。
这是一项单中心横断面研究，研究纳入了根据该算法连续检查ILD 的新诊断为 SARD 的患者。所有纳入的患者均行胸部高分辨率 CT 扫描（HRCT），并检测血清 CA 15-3、KL-6 和乳酸脱氢酶（LDH）水平，并与其他与可能存在 ILD 相关的变量相关联。
ILD 阳性患者的血清生物标志物水平，特别是 CA 15-3 和 LDH，明显升高（两者均 P<0.001）。FVC 值越高，CA 15-3 水平越低，两者呈负相关（Rho=-0.291，P=0.007）。同样，更高的 DLCO 值与更低的 CA 15-3 水平相关（Rho=-0.317，P=0.003）。我们的研究结果表明，CA 15-3 水平升高与 KL-6（Rho=0.268，P=0.01）和 LDH（Rho=0.227，P=0.04）水平升高呈正相关。当 CA 15-3 的截断值为 24 U/mL 时，CA 15-3 的敏感性和特异性最高（AUC=0.807，特异性为 95.7%，敏感性为 71.1%）。CA 15-3 是 HRCT 阳性发现的最显著预测因子，可准确分类 83%的病例。
这些结果表明，CA 15-3 作为一种有价值的血清生物标志物，有望用于 SARD 患者的ILD 常规临床筛查。
