Wu Shi, Liu Hua, Yin Shijia, Wang Yun, Liu Xiaoxiao, Ding Zhen
Department of Respiratory and Critical Care Medicine, the Third Affiliated Hospital of Anhui Medical University, Hefei, China.
Anhui Institutes for Food and Drug Control, Hefei, China.
J Thorac Dis. 2025 Mar 31;17(3):1364-1376. doi: 10.21037/jtd-24-1882. Epub 2025 Mar 14.
This study aims to elucidate the capability of periostin (POSTN) as a serum biomarker in diagnosing idiopathic pulmonary fibrosis (IPF), assessing disease severity, and predicting acute exacerbations of IPF (AE-IPF), and to compare it with traditional IPF serum biomarkers Krebs von den Lungen-6 (KL-6), surfactant protein A (SP-A), and surfactant protein D (SP-D).
From October 2022 to October 2023, 55 patients who were diagnosed with IPF and treated at the Third Affiliated Hospital of Anhui Medical University were enrolled in the IPF group. Additionally, 30 patients with bacterial pneumonia (BP) and 30 healthy individuals were selected as the BP and healthy control (HC) groups, respectively. All participants underwent pulmonary function tests, and enzyme-linked immunosorbent assay (ELISA) was used to measure serum POSTN, KL-6, SP-A, and SP-D levels. IPF patients also underwent high-resolution computed tomography (HRCT) to quantify HRCT scores. Receiver operating characteristic (ROC) curves were plotted to obtain sensitivity and specificity. Binary logistic regression analysis was conducted to identify AE-IPF risk factors.
Serum POSTN, KL-6, SP-A, and SP-D concentrations were significantly greater in the IPF group than in the BP and HC groups (P<0.001), whereas serum SP-A and SP-D levels were greater in the BP group than in the HC group (P=0.001, P=0.04). The sensitivity of POSTN for diagnosing IPF is 94.5%, and the specificity is 93.3%, both of which are higher than those of KL-6, SP-A, and SP-D. Within the IPF group, serum POSTN levels were negatively correlated with the percentage of predicted forced expiratory volume in one second (FEV%pred) (P=0.01) and the percentage of the predicted diffusing capacity for carbon monoxide (DLCO%pred) (P=0.003). Additionally, in IPF patients, serum POSTN, KL-6, and SP-A levels were significantly positively associated with HRCT scores. Logistic regression analysis indicated that decreased DLCO%pred and increased baseline serum KL-6 levels were both independent risk factors for AE-IPF.
POSTN is a valuable serum biomarker for IPF and has the highest sensitivity and specificity among the four serum markers, with a diagnostic performance superior to that of KL-6, SP-A, and SP-D. DLCO%pred and KL-6 have high predictive value for AE-IPF.
本研究旨在阐明骨膜蛋白（POSTN）作为血清生物标志物在诊断特发性肺纤维化（IPF）、评估疾病严重程度以及预测IPF急性加重（AE-IPF）方面的能力，并将其与传统的IPF血清生物标志物肺肿瘤标志物-6（KL-6）、表面活性蛋白A（SP-A）和表面活性蛋白D（SP-D）进行比较。
2022年10月至2023年10月，选取安徽医科大学第三附属医院确诊并接受治疗的55例IPF患者纳入IPF组。另外，分别选取30例细菌性肺炎（BP）患者和30例健康个体作为BP组和健康对照（HC）组。所有参与者均接受肺功能测试，并采用酶联免疫吸附测定（ELISA）法检测血清POSTN、KL-6、SP-A和SP-D水平。IPF患者还接受了高分辨率计算机断层扫描（HRCT）以量化HRCT评分。绘制受试者工作特征（ROC）曲线以获得敏感性和特异性。进行二元逻辑回归分析以确定AE-IPF的危险因素。
IPF组血清POSTN、KL-6、SP-A和SP-D浓度显著高于BP组和HC组（P<0.001），而BP组血清SP-A和SP-D水平高于HC组（P=0.001，P=0.04）。POSTN诊断IPF的敏感性为94.5%，特异性为93.3%，均高于KL-6、SP-A和SP-D。在IPF组内，血清POSTN水平与预测的一秒用力呼气容积百分比（FEV%pred）（P=0.01）和预测的一氧化碳弥散量百分比（DLCO%pred）（P=0.003）呈负相关。此外，在IPF患者中，血清POSTN、KL-6和SP-A水平与HRCT评分显著正相关。逻辑回归分析表明，DLCO%pred降低和基线血清KL-6水平升高均是AE-IPF的独立危险因素。
POSTN是IPF的一种有价值的血清生物标志物，在四种血清标志物中具有最高的敏感性和特异性，诊断性能优于KL-6、SP-A和SP-D。DLCO%pred和KL-6对AE-IPF具有较高的预测价值。
