| Objective: The serum levels of Krebs von den Lungen-6 were measured to compare idiopathic pulmonary fibrosis with other non-IPF interstitial diseases and non-interstitial lung disease.Analyze the correlation between the expression of serum KL-6 and pulmonary function in IPF patients,and to search and screen the original literature on the differential expression with IPF,non-IPF-ILD and non-ILD,the correlation between the expression of serum KL-6 and pulmonary function in IPF patients,and the correlation between and prognosis in IPF patients.Comprehensive exploration the value of KL-6 in diagnosis,assessment and prognosis of IPF.Methods(1)In the case-control study of our hospital,we collected 20 cases of IPF patients who were hospitalized in our hospital,18 cases of connective tissue disease related interstitial lung disease,12 cases of hypersensitivity pneumonitis,8 cases of sarcoidosis,twenty patients with other interstitial lung disease and 20 patients with non-interstitial lung disease were classified.General information of all patients was collected.Pulmonary function of IPF patients was collected.Serum of all patients was collected.Enzyme Linked Immunosorbent Assay was used to detect the expression level of serum KL-6 in IPF patients and other control groups in our hospital.The expression level of serum KL-6 in IPF patients was compared with other groups.The correlation between the expression level of serum KL-6 in IPF patients and pulmonary function was analyzed by spss23.(2)The original literature including KL-6 expression difference in different patients’ serum,correlation with pulmonary function and prognostic data including total survival time and mortality risk ratio of IPF patients before December 2018 was retrieved.Literature quality was evaluated by Newcastle-Ottawa Scale.Finally,statistical methods and STATA 14 were used to do the meta-meta-analysis of the original data in terms of expression differences,correlation with pulmonary function and prognosis.Results(1)In the sample of our hospital:(1)The expression of KL-6 in serum of IPF group and control group: There was no significant difference between the expression of KL-6 in serum of IPF group and that of non-IPF-ILD group,(1295.29+446.04)U/ml to(1061.93+545.98)U/ml,P > 0.05;there was no significant difference between IPF group and CTD-ILD group(1295.29+446.04)U/ml to(1388.17±520.01)U/ml,P > 0.05;There was no significant difference compared with other unclassified ILD groups(1295.29±446.04)U/ml to(1233.65±455.94)U/ml,P > 0.05);There was significantly higher than HP group(1295.29±446.04)U/ml to(735.92±233.74)U/ml,P < 0.05;significantly higher than SAR group(1295.29±446.04)U/ml to(387.63±154.31)U/ml,P < 0.05.(2)The level of serum KL-6 expression in Idiopathic pulmonary fibrosis group was negatively correlated with forced vital capacity and carbon monoxide diffusion capacity,with correlation coefficients of-0.474 and-0.545 respectively(P < 0.05).(2)In the past meta-meta-meta-analysis,the following results were obtained:(1)The expression level of KL-6 in serum of IPF patients and its comparison with other groups: The expression level of KL-6 in serum of IPF patients was significantly higher than that of healthy control group.SMD = 2.854,95% CI:[2.135-3.572],Z= 7.78,P < 0.001;The expression of KL-6 in serum of IPF patients was significantly higher than that of pulmonary infection group,SMD = 2.040,95% CI:[1.338-2.741],Z = 5.70,P < 0.001;The expression level of KL-6 in serum of IPF patients was significantly higher than that of non-infected lung group,SMD = 2.346,95% CI:[1.794-2.887],Z = 8.39,P < 0.001;There was no significant difference in serum KL-6 expression between IPF patients and non-IPF-ILD patients.SMD = 0.102,95% CI: [-0.201-0.404],Z = 0.66,P = 0.510;There was no significant difference in serum KL-6 expression between IPF patients and non-specific interstitial pneumonia patients.SMD=-0.151,95% CI:[-0.555-0.252],Z= 0.73,P= 0.463;There was no significant difference in serum KL-6 expression between IPF patients and CTD-ILD group.SMD = 0.013,95% CI: [-0.220-0.246],Z = 0.11,P = 0.914;There was no significant difference in serum KL-6 expression between IPF patients and those with collagen vascular diseaseassociated interstitial pneumonia,SMD= 0.415,95% CI:[-0.347-1.176],Z= 1.07,P= 0.286;The expression level of KL-6 in serum of IPF patients significantly increased to Sar group,SMD = 1.231,95% CI:[0.914-1.548],Z = 7.61,P < 0.001;The expression level of KL-6 in serum of IPF patients had no significant difference with HP group,SMD=-0.338,95% CI:[-0.982-0.305],Z= 1.03,P= 0.303;Compared with cryptogenic organic pneumonia,the expression of KL-6 in serum of IPF patients was significantly higher,SMD = 0.804,95% CI:[0.197-1.410],Z = 2.60,P = 0.009.The expression level of KL-6 in acute IPF patients was significantly higher than that in stable IPF patients,SMD= 0.738,95% CI:[0.435-1.041],Z= 4.77,P < 0.001.(2)Analysis of correlation between serum KL-6 expression level and pulmonary function in IPF patients: There was a moderate negative correlation between serum KL-6 expression level and FVC% in IPF patients.Summary fisher’s Z=-0.517,95% CI:[-0.728--0.305],Z= 4.79,P<0.001;There was a moderate negative correlation between serum KL-6 expression level and DLCO% in IPF patients,Summary fisher’s Z=-0.520,95% CI [-0.727].-0.313],Z = 4.93,P < 0.001;(3)The level of serum KL-6 expression in IPF patients was correlated with the prognosis of IPF patients:The expression level of KL-6 in serum of IPF patients was significantly correlated with the prognosis of IPF patients.The high expression level of serum KL-6 was significantly correlated with the increased risk of death.The Hazard ratio(HR)= 2.119,95% CI:[1.300-3.453],Z= 3.01,P = 0.003;Conclusion:(1)Although the expression of KL-6 in serum is limited in the diagnosis and differential diagnosis of IPF patients,it still has certain value in differential diagnosis and exclusion diagnosis.(2)The expression of KL-6 in serum of AE-IPF patients was significantly higher than that of Sta-IPF patients,and was negatively correlated with pulmonary function of IPF patients,which could provide certain value for judging patients’ condition.(3)Prognostic correlation analysis showed that KL-6 level was significantly correlated with the mortality risk of IPF patients,which could provide a certain prognostic value for IPF patients. |
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