类风湿关节炎患者血清KL-6和IL-33的表达水平及其临床意义

黄月; 魏小松; 江超; 吴汉霞; 王涛; 李志军

doi:10.16766/j.cnki.issn.1674-4152.003242

类风湿关节炎患者血清KL-6和IL-33的表达水平及其临床意义

doi: 10.16766/j.cnki.issn.1674-4152.003242

黄月^{1, 2},
魏小松¹,
江超¹,
吴汉霞²,
王涛^{1, 3},
李志军^{1, 3, ,}

1.
蚌埠医学院第一附属医院风湿免疫科，安徽蚌埠 233004
2.
安徽理工大学第一附属医院风湿免疫科，安徽淮南 232000
3.
慢性疾病免疫学基础与临床安徽省重点实验室，安徽蚌埠 233004

基金项目:

安徽省卫生健康软科学研究项目 2020WR03013

详细信息

通讯作者:
李志军，E-mail：lizhijundr@126.com

中图分类号: R593.22
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- 被引次数: 0
出版历程
- 收稿日期: 2023-04-08
- 网络出版日期: 2024-01-13

Expression levels of serum Krebs von den Lungen-6 and interleukin 33 in rheumatoid arthritis patients and their clinical significance

HUANG Yue^{1, 2},
WEI Xiaosong¹,
JIANG Chao¹,
WU Hanxia²,
WANG Tao^{1, 3},
LI Zhijun^{1, 3
, ,}

1.
Department of Rheumatology and Immunology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的了解类风湿关节炎(RA)患者血清涎液化糖链抗原6(KL-6)和白细胞介素33(IL-33)的表达水平，探讨检测血清KL-6和IL-33对RA相关间质性肺病(RA-ILD)的诊断价值。方法选择2022年5月—2023年2月在蚌埠医学院第一附属医院和安徽理工大学第一附属医院风湿科住院并确诊为RA的患者88例，根据肺部CT有无间质性肺病(ILD)分为一般RA组(40例)和RA-ILD组(48例)。所有患者均检测与RA相关的血清学指标，如血清类风湿因子(RF)、红细胞沉降率(ESR)和抗环瓜氨酸肽抗体(抗CCP抗体)等。同时检测上述患者血清KL-6和IL-33水平，分析各项指标与ILD的相关性，通过受试者工作特征(ROC)曲线分析各指标对RA-ILD的诊断效能。结果 RA-ILD组患者血清KL-6、IL-33水平显著升高；血清KL-6与ESR、CRP、D-二聚体呈正相关关系，血清IL-33与IgG、球蛋白呈正相关关系。经ROC曲线分析发现，各项指标(RF、ESR、CRP、D-二聚体、IgA、KL-6、IL-33)诊断RA-ILD的曲线下面积(AUC)分别为0.678、0.667、0.716、0.702、0.666、0.773和0.705。KL-6、IL-33联合检测诊断RA-ILD的AUC为0.816，均优于各项单独检测。结论联合检测RA患者血清KL-6和IL-33，对RA-ILD的早期诊断及病情严重性判断有较高的参考价值。
- 涎液化糖链抗原6 /
- 白细胞介素33 /
- 类风湿关节炎 /
- 间质性肺病
Abstract: Objective To understand the expression levels of serum Krebs von den Lungen-6 (KL-6) and interleukin 33 (IL-33) in patients with rheumatoid arthritis (RA), and to investigate the diagnostic value of detecting serum KL-6 and IL-33 in RA-associated interstitial lung disease (RA-ILD). Methods A total of 88 patients diagnosed with RA who were admitted to the Rheumatology Department of the First Affiliated Hospital of Bengbu Medical College and the First Affiliated Hospital of Anhui Hospital of Science and Technology from May 2022 to February 2023 were selected. They were divided into general RA group (40 cases) and RA-ILD group (48 cases) according to the presence of interstitial lung disease (ILD) on lung CT. Serological indicators of RA, such as serum rheumatoidfactors (RF), erythrocytesedimentationrate (ESR) and anticyclic citrullinated peptide antibody (anti-CCP) were found in all patients. At the same time, the levels of serum KL-6 and IL-33 in the above patients were determined, the correlation between each index and ILD was analyzed, and the diagnostic efficiency of each index for RA-ILD was analyzed by receiver operating characteristic (ROC) curve. Results Serum KL-6 and IL-33 levels were significantly increased in RA-ILD group; serum KL-6 was positively correlated with ESR, CRP, and D-dimer, and serum IL-33 was positively correlated with IgG and globulin. After ROC analysis, the area under the curve (AUC) of each index for diagnosing RA-ILD was RF (0.678), ESR (0.667), CRP (0.716), D-dimer (0.702), IgA (0.666), KL-6 (0.773) and IL-33 (0.705). The AUC of combined detection of KL-6 and IL-33 in diagnosing RA-ILD was 0.816, both of which were superior to individual detection. Conclusion The combined detection of serum KL-6 and IL-33 in RA patients has a high reference value for the early diagnosis of RA-ILD and the assessment of disease severity.
- Krebs von den Lungen 6 /
- Interleukin 33 /
- Rheumatoid arthritis /
- Interstitial lung disease

HTML全文

图 1 各项血清免疫学指标的ROC曲线

注: A为RF、ESR、CRP、IgA、D-二聚体、KL-6和IL-33各项指标单独应用; B为KL-6、IL-33指标联合应用。

Figure 1. ROC curves of various serum immunological indices

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表 1 2组RA患者关节表现情况比较[例(%)]

Table 1. Comparison of joint performance between two groups of RA patients [cases(%)]

组别	例数	多关节受累	寡关节受累	单关节受累	无关节压痛
一般RA组	40	23(57.5)	9(22.5)	2(5.0)	6(15.0)
RA-ILD组	48	30(62.4)	9(18.8)	2(4.2)	7(14.6)
注：寡关节受累指受累关节数2~4个，多关节受累指受累关节数≥5个。2组关节表现情况比较，Z=0.496, P=0.620。

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表 2 2组RA患者实验室检测结果比较

Table 2. Comparison of laboratory test results between two groups of RA patients

组别	例数	抗CCP抗体(%)	RF [M(P₂₅, P₇₅)，U/mL]	ESR [M(P₂₅, P₇₅)，mm/h]	CRP [M(P₂₅, P₇₅)，mg/L]	D-二聚体[M(P₂₅, P₇₅)，mg/L]	IgA [M(P₂₅, P₇₅)，g/L]
一般RA组	40	32.5(13/40)	101.14(32.24, 150.41)	28.5(14.0, 52.0)	5.0(0.0, 21.0)	0.60(0.30, 1.41)	2.46(1.69, 2.94)
RA-ILD组	48	60.4(27/48)	148.61(110.02, 206.99)	41.5(30.0, 80.0)	26.5(4.0, 50.0)	1.44(0.72, 2.31)	3.12(2.16, 4.04)
统计量		6.816^a	2.866^b	2.697^b	3.464^b	3.549^b	2.669^b
P值		0.009	0.004	0.007	0.001	＜0.001	0.008
注：^a为χ²值，^b为Z值。

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表 3 2组RA患者KL-6与IL-33水平比较[M(P₂₅, P₇₅)]

Table 3. Comparison of KL-6 and IL-33 levels between two groups of RA patients [M(P₂₅, P₇₅)]

组别	例数	KL-6(U/mL)	IL-33(pg/mL)
一般RA组	40	204.70(140.85, 272.70)	18.88(6.04, 66.26)
RA-ILD组	48	356.20(237.00，528.80)	85.89(26.81，182.92)
Z值		10.267	6.480
P值		0.001	0.011

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表 4 各项血清免疫学指标对RA-ILD的诊断效能

Table 4. Diagnostic efficacy of various serum immunologic indices for RA-ILD

项目	临界值	灵敏度(%)	特异度(%)	约登指数	AUC(95%CI)
RF	97.05 U/mL	83.3	50.0	0.333	0.678(0.564~0.792)
ESR	33.5 mm/h	72.9	60.0	0.329	0.667(0.554~0.781)
CRP	34 mg/L	45.8	87.5	0.333	0.716(0.609~0.823)
IgA	3.01 g/L	56.3	82.5	0.388	0.666(0.552~0.780)
D-二聚体	0.605 mg/L	85.4	52.5	0.379	0.702(0.591~0.812)
KL-6	300.95 U/mL	60.4	85.0	0.454	0.773(0.677~0.870)
IL-33	81.17 pg/mL	54.2	82.5	0.367	0.705(0.596~0.814)
KL-6和IL-33联合检测		81.9	97.4	0.793	0.816(0.730~0.901)

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