摘要
目的 探讨血清表面活性蛋白-A(SP-A)、表面活性蛋白-D(SP-D)、高迁移率族蛋白B1(HMGB1)、涎液化糖链抗原-6(KL-6)、微小核糖核酸-21(miR-21)与老年急性加重特发性肺纤维化(AE-IPF)及肺功能的关系,以提高AE-IPF早期诊断率、防范误诊的发生.方法 选取2023 年1 月至2024 年 1 月收治的老年AE-IPF患者 80 例为AE-IPF组,另选择同期就诊的80 例老年稳定特发性肺纤维化(IPF)患者为IPF组及50 例体检健康老年人为对照组.比较3 组血清 SP-A、SP-D、HMGB1、KL-6、miR-21 及肺功能指标[第 1 秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、第1 秒用力呼气容积占预计值百分比(FEV1%pred)、1 min最大自主通气量(MVV)、1 min最大自主通气量占预计值百分比(MVV%pred)、肺一氧化碳弥散量占预计值百分比(DLCO%pred)].分析血清SP-A、SP-D、HMGB1、KL-6、miR-21 诊断AE-IPF的价值;分析血清SP-A、SP-D、HMGB1、KL-6、miR-21 与肺功能指标的相关性.结果 IPF组、AE-IPF组血清SP-A、SP-D、HMGB1、KL-6、miR-21 高于对照组,且AE-IPF组高于IPF组(P＜0.05).血清SP-A、SP-D、HMGB1、KL-6、miR-21 诊断AE-IPF发生的曲线下面积分别为 0.866、0.882、0.890、0.793、0.783,敏感度分别为0.800、0.825、0.800、0.763、0.813.AE-IPF组、IPF组FEV1、FEV1/FVC、FEV1%pred、MVV、MVV%pred、DLCO%pred均低于对照组,AE-IPF 组低于 IPF 组(P＜0.05).血清 SP-A、SP-D、HMGB1、KL-6、miR-21 与 FEV1、FEV1/FVC、FEV1%pred、MVV、MVV%pred、DLCO%pred 均呈负相关(P＜0.01).结论 检测血清 SP-A、SP-D、HMGB1、KL-6、miR-21 表达情况可提高AE-IPF早期诊断率,防范误诊误治的发生.
Abstract
Objective To investigate the relationship of serum surfactant protein-A(SP-A),serum surfactant pro-tein-D(SP-D),high mobility group box-1 protein(HMGB1),Krebs von den Lungen-6(KL-6),and microribonuclease-21(miR-21)with acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF)and pulmonary function in elderly patients,in order to improve the early diagnosis rate of AE-IPF and prevent misdiagnosis.Methods A total of 80 elderly patients with AE-IPF admitted from January 2023 to January 2024 were selected as AE-IPF group,another 80 elderly patients with stable idiopathic pulmonary fibrosis(IPE)admitted during the same period were selected as IPF group and 50 healthy elderly pa-tients undergoing physical examination were selected as control group.SP-A,SP-D,HMGB1,KL-6,miR-21 and pulmonary function indexes[forced expiratory volume in the first second(FEV1),FEV1/forced vital capacity(FVC),forced expiratory volume in the first second to the predicted value(FEV1%pred),maximum voluntary ventilation(MVV),maximal voluntary ventilation as a percentage of estimated value(MVV%pred),diffusing capacity of the lungs for carbon monoxide as a percent-age of estimated value(DLCO%pred)]were compared among the three groups.The diagnostic value of serum SP-A,SP-D,HMGB1,KL-6 and miR-21 in AE-IPF was analyzed,and the correlation between serum SP-A,SP-D,HMGB1,KL-6 and miR-21 and pulmonary function indexes was analyzed.Results SP-A,SP-D,HMGB1,KL-6 and miR-21 in IPF group and AE-IPF group were higher than those in control group,and higher in AE-IPF group than in IPF group(P＜0.05).The area under the curve of serum SP-A,SP-D,HMGB1,KL-6,and miR-21 for the diagnosis of AE-IPF was 0.866,0.882,0.890,0.793,and 0.783,respectively,and the sensitivity was 0.800,0.825,0.800,0.763,and 0.813,respectively.FEV1,FEV1/FVC,FEV1%pred,MVV,MVV%pred and DLCO%pred in AE-IPF group and IPF group were lower than those in control group,and lower in AE-IPF group than in IPF group(P＜0.05).Serum SP-A,SP-D,HMGB1,KL-6 and miR-21 were negatively correlated with FEV1,FEV1/FVC,FEV1%pred,MVV,MVV%pred and DLCO%pred(P＜0.01).Con-clusion The detection of the expressions of serum SP-A,SP-D,HMGB1,KL-6 and miR-21 can improve the early diagnosis rate of AE-IPF and prevent misdiagnosis and mistreatment.
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