血清克雷伯氏肺癌-6水平升高可预测合并特发性肺纤维化和阻塞性睡眠呼吸暂停患者的死亡情况。

Elevated Serum Level of Krebs von den Lungen-6 Predicts Death in Patients With Comorbid Idiopathic Pulmonary Fibrosis and Obstructive Sleep Apnea.

作者信息

Li Fei, Geng Jing, Zhang Hehe, Xie Bingbing, Zhang Hui, Xie Jiang, Dai Huaping

机构信息

Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China.

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing, 100029, People's Republic of China.

出版信息

Nat Sci Sleep. 2025 May 19;17:975-985. doi: 10.2147/NSS.S506975. eCollection 2025.

DOI:10.2147/NSS.S506975

PMID:40417308

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12101450/

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is prevalent in patients with idiopathic pulmonary fibrosis (IPF). This study evaluated the prognostic significance of Krebs von den Lungen-6 (KL-6) levels in patients with comorbid OSA and IPF.

METHODS

This retrospective research included 115 individuals diagnosed with IPF between January 2015 and December 2020, all of whom completed sleep tests and underwent measurement of serum KL-6 levels during hospitalization. To ascertain the risk factors associated with all-cause death, a multivariate Cox regression model was employed, adjusted for confounding variables of age, sex, and pulmonary function.

RESULTS

During the 40-month follow-up, 24 (20.9%) deaths occurred, with 17 (28.8%) in the OSA group and 7 (12.5%) in the non-OSA group. Patients with OSA had higher baseline KL-6 levels than did those without OSA. Both apnea-hypopnea index (hazard ratio [HR] = 1.023, 95% confidence interval [CI] 1.000-1.047, = 0.049) and serum KL-6 levels (HR = 1.001, 95% CI 0.999-1.002, = 0.032) were identified as independent risk factors for death in multivariable Cox analysis. For the overall cohort of patients with IPF, those with a KL-6 levels ≥1200 U/mL had a higher risk of death in both univariate analysis (HR = 5.694, 95% CI 1.945-16.669, = 0.002) and adjusted models (HR = 5.245, 95% CI 1.775-15.494, = 0.003). In the subgroup analysis, the independent prognostic significance of KL-6 levels ≥1200 U/mL for death was evident only in IPF patients with concurrent OSA (HR = 4.887, 95% CI 1.082-22.067, = 0.039), whereas it was not observed yet in IPF patients without OSA (HR = 4.652, 95% CI 0.616-35.131, = 0.136).

CONCLUSION

KL-6 level is of prognostic value in patients with comorbid IPF and OSA. These findings underscore the need for sleep tests and KL-6 measurement for IPF patients at high risk.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）在特发性肺纤维化（IPF）患者中很常见。本研究评估了克雷伯氏肺炎-6（KL-6）水平在合并OSA和IPF患者中的预后意义。

方法

这项回顾性研究纳入了2015年1月至2020年12月期间诊断为IPF的115名个体，他们均完成了睡眠测试并在住院期间进行了血清KL-6水平测量。为确定与全因死亡相关的危险因素，采用多变量Cox回归模型，并对年龄、性别和肺功能等混杂变量进行了调整。

结果

在40个月的随访期间，发生了24例（20.9%）死亡，其中OSA组17例（28.8%），非OSA组7例（12.5%）。OSA患者的基线KL-6水平高于无OSA患者。在多变量Cox分析中，呼吸暂停低通气指数（风险比[HR]=1.023，95%置信区间[CI]1.000-1.047，P=0.049）和血清KL-6水平（HR=1.001，95%CI 0.999-1.002，P=0.032）均被确定为死亡的独立危险因素。对于IPF患者的总体队列，KL-6水平≥1200 U/mL的患者在单变量分析（HR=5.694，95%CI 1.945-16.669，P=0.002）和校正模型（HR=5.245，95%CI 1.775-15.494，P=0.003）中死亡风险均较高。在亚组分析中，KL-6水平≥1200 U/mL对死亡的独立预后意义仅在合并OSA的IPF患者中明显（HR=4.887，95%CI 1.082-22.067，P=0.039），而在无OSA的IPF患者中未观察到（HR=4.652，95%CI 0.616-35.131，P=0.136）。