CAJ | 학술논문

目的探讨类风湿关节炎(RA)合并间质性肺病(ILD)患者的血清表面活性蛋白A(SP-A)和D(SP-D)水平及临床意义.方法采用双抗体夹心酶联免疫吸附试验(ELISA)法检测SP-A和SP-D,并比较单纯RA组、RA-ILD组、对照组血清样本SPA和SP-D水平的差异,分析其与RA合并ILD的相关性.计算3组血清SP-A和SP-D阳性检出率.分析SP-A和SP-D与年龄、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体、抗核抗体、抗核周因子(APF)和抗角蛋白抗体(AKA)之间的相关性.多组间均数的比较采用方差分析,数据间的相关性分析采用Spearman等级相关.结果 ①RA-ILD组、单纯RA组、对照组的血清SP-A水平分别为(51.2±9.2)、(25.9±2.6)、(15.4±0.3)μg/L,SP-D水平分别为(42.5±8.1)、(20.8±1.5)、(16.6±0.8)μg/L.RA-ILD组患者血清SP-A和SP-D水平高于单纯RA组以及对照组(P＜0.05).单纯RA组患者血清SP-A和SP-D水平和健康对照组比较差异无统计学意义(P＞0.05).②RA-ILD组血清SP-A和SP-D的阳性率明显高于单纯RA组(x2=5.21,P=0.02;x2=4.79,P=0.01)和健康对照组(x2=4.96,P=0.03;x2=4.75,P=0.02),RA-ILD组血清SP-D的阳性检出率大于血清SP-A(x2=4.95,P=0.04).③RA-ILD患者血清SP-A、SP-D水平与年龄、CRP呈正相关(r=0.687,P=0.001；r=0.571,P=0.009).④RA-ILD患者血清SP-D水平与RF、抗CCP抗体和AKA呈正相关,而血清SP-A、SP-D水平与抗核抗体、APF、ESR无相关性.结论 ①SP-A和SP-D可作为RA合并ILD的血清学标志;②SP-A和SP-D在早期诊断RA合并ILD方面有一定价值,SP-D更有效地提示RA合并ILD存在,判断肺损伤程度,预测疾病转归情况.
목적 탐토류풍습관절염(RA)합병간질성폐병(ILD)환자적혈청표면활성단백A(SP-A)화D(SP-D)수평급림상의의.방법 채용쌍항체협심매련면역흡부시험(ELISA)법검측SP-A화SP-D,병비교단순RA조、RA-ILD조、대조조혈청양본SPA화SP-D수평적차이,분석기여RA합병ILD적상관성.계산3조혈청SP-A화SP-D양성검출솔.분석SP-A화SP-D여년령、홍세포침강솔(ESR)、C반응단백(CRP)、류풍습인자(RF)、항배과안산태(CCP)항체、항핵항체、항핵주인자(APF)화항각단백항체(AKA)지간적상관성.다조간균수적비교채용방차분석,수거간적상관성분석채용Spearman등급상관.결과 ①RA-ILD조、단순RA조、대조조적혈청SP-A수평분별위(51.2±9.2)、(25.9±2.6)、(15.4±0.3)μg/L,SP-D수평분별위(42.5±8.1)、(20.8±1.5)、(16.6±0.8)μg/L.RA-ILD조환자혈청SP-A화SP-D수평고우단순RA조이급대조조(P＜0.05).단순RA조환자혈청SP-A화SP-D수평화건강대조조비교차이무통계학의의(P＞0.05).②RA-ILD조혈청SP-A화SP-D적양성솔명현고우단순RA조(x2=5.21,P=0.02;x2=4.79,P=0.01)화건강대조조(x2=4.96,P=0.03;x2=4.75,P=0.02),RA-ILD조혈청SP-D적양성검출솔대우혈청SP-A(x2=4.95,P=0.04).③RA-ILD환자혈청SP-A、SP-D수평여년령、CRP정정상관(r=0.687,P=0.001；r=0.571,P=0.009).④RA-ILD환자혈청SP-D수평여RF、항CCP항체화AKA정정상관,이혈청SP-A、SP-D수평여항핵항체、APF、ESR무상관성.결론 ①SP-A화SP-D가작위RA합병ILD적혈청학표지;②SP-A화SP-D재조기진단RA합병ILD방면유일정개치,SP-D경유효지제시RA합병ILD존재,판단폐손상정도,예측질병전귀정황.
Objective To measure serum surfactant protein (SP) A and D levels in patients with interstitial lung disease associated with rheumatoid arthritis (RA).Methods Serum SP-A and SP-D levels of RA,RA-ILD patients and healthy controls were assessed using a sensitive enzyme-linked immunosorbent assay (ELISA).The relationship between SP-A and SP-D and RA-ILD was analyzed.The serum SP-A and SP-Dpositive rate was calculated for the three groups.The correlation between SP-A and SP-D with RF,anti-CCP,antinuclear antibody,antikeratin antibody,anti-perinuclear factor,C-reactive protein,erythrocyte sedimentation rate,were analyzed.Mean value of groups were compared with variance analysis,Spearmam rank correlation test was used for correlation analysis.Results The levels of serum SP-A in RA-ILD patients and RA patients as well as in healthy controls were [ (51.2±9.2),(25.9±2.6),( 15A±0.3 ) μg/L] respectively.The level of serum SP-D of the three groups was [ ( 42.5 ±8.1 ),(20.8 ± 1.5 ),( 16.6±0.8 ) μg/L ] respectively.The levels of serum SP-A and SP-D in patients with RA complicated with ILD were higher than those simple RA patients and healthy controls (P＜0.05).The levels of serum SP-A and SP-D in patients with RA were not significantly higher than those in healthy controls (P＞0.05).The positive rate of serum SP-A and SP-D in RA-ILD patients were significantly higher than those in simple RA patients and healthy controls.The positive rate of serum SP-D of RA-ILD patients was higher than that of SP-A.The levels of serum SP-A and SP-D in patients with RA complicated with ILD were correlated positively with age,C-reactive protein.The level of serum SP-D was correlated positively with RF,anti-CCP,antikeratin antibody.There was no correlation between the level of serum SP-A and SP-D with RA-ILD and antinuclear antibody,antiperinuclear factor,erythrocyte sedimentation rate.Conclusion The levels of serum SP-A and SP-D are correlated with RA-ILD and may be useful markers for ILD in patients with RA.These two paramenters may be helpful to early diagnosis of RA-ILD.The Serum SP-D levels are more sensitive in predicting the development of RA-ILD than other parameters and can help in assessing the severity of lung damage.