| Objective:To investigate the clinical significance of serum chemokine-4(CXCL-4)in systemic sclerosis patients complicated with interstitial lung disease(SSc-ILD).Method:62 patients with SSc who meet the new classification criteria of ACR / EULAR systemic sclerosis(SSc)in 2013 treated by rheumatology department of Jiangxi Provincial People's Hospital from September 2015 to July 2017 were divided into SSc combined with ILD group(group A)and simple SSc group(group B)according to the results of HRCT test,in reference to the 2010 American Thoracic Society / European Respiratory Society(ATS/ERS)ILD diagnosis standard.A certain number of healthy subjects were selected as healthy control group(group C).Serum concentrations of CXCL-4 were determined by enzyme-linked immunosorbent assay(ELISA),and the difference of CXCL-4 concentration among the 3 groups were analyzed.All data were analyzed by SPSS17.0 statistical software,with P <0.05 for the difference was statistically significant.Result:In the study of 62 SSc patients,Raynaud's phenomenon,joint involvement,skin sclerosis could occurred in the course of the disease,and ILD was identified in 30 patients(48.4%),respiratory symptoms such as dry cough after exercise,chest distress and dyspnea could also occurred in the cases of SSc-ILD.The main abnormal performance of SSc-ILD in HRCT was mainly ground-glass opacity and reticular pattern involved in the subpleural under double pulmonary lobes,fibrotic streaks and alveolate image could be observed in later stage.It was found that there was no significant difference in the course of disease,age,sex ratio,smoking rate,clinical subtype and Reynolds phenomenon in the two groups(P>0.05),while the skin score(MRSS)in group SSc-ILD was higher than that of simple SSc group,the difference was statistically significant(17.0±10.15 vs 12.28±7.76 points,P=0.046).In the comparison of laboratory indexes,there was no significant difference in ESR,CRP,IgA,IgM between the SSc-ILD group and the SSc group(P>0.05),while IgG in SSc-ILD group was significantly higher than the SSc group(16.93±6.24 vs 13.48±4.75g/ L,P=0.017),SSc patients may had positive antibodies such as ANA,ACA,U1-RNP,SSA,SSB,Ro-52,PM-Scl,Scl-70,and CENPB.Compared with SSc-ILD group,the positive rate of ACA was significantly lower than that of SSc group(2/30 vs 9/32,P=0.02),and there was no significant difference in other antibodies between the two groups(P>0.05).In the comparison of pulmonary function indexes,the indexes such as RV and FEV1/FVC were not significantly different between the two groups(P>0.05),while the DLCO,VC,FVC,TLC of the SSc-ILD patients were significantly lower than those of the SSc group(50.23±20.83 vs 74.53±18.22%,P<0.001;74.07±19.09 vs 86.06±19.38%,P=0.017;70.03±18.60 vs 87.06 ± 19.03%,P=0.001;87.70 ± 22.98 vs 103.72 ± 28.19%,P=0.018).Comparison of serum CXCL-4 levels among the two groups of patients with the normal control group we found that the level of CXCL-4 in the SSc-ILD group was higher than that of the simple SSc group(133.0±17.23 vs 121.6±18.83 ng/ml,P=0.012)and the normal control group(133.0±17.23 vs.115.1±18.77 ng/ml,P=0.000),while there was no significant difference between the simple SSc group and the normal control group(121.6±18.83 vs 115.1±18.77 ng/ml,P> 0.05).Multivariate logistic regression analysis showed that CXCL-4 levels and MRSS were factors affecting SSc concurrent ILD(P=0.019,OR=1.035,95% CI=1.006-1.066;P=0.04,OR=1.103,95% CI= 1.004-1.211).Correlation analysis of CXCL-4 levels with pulmonary function in SSc patients revealed a negative correlation between CXCL-4 and DLCO and FVC(r-0.384,P=0.002;r-0.496,P<0.001).Conclusion:1.Patients with higher skin scores at the time of their initial visit are more likely to have ILD,and should be wary of concurrent or progression to SSc-ILD.2.ILD is one of the most common and serious complications of SSc.At present,the combination of HRCT and PFT in newly diagnosed patients is still an important method for early detection of ILD.3.The high level of CXCL-4 is associated with the onset of SSc-ILD and the deterioration of lung function.It is expected to be a specific serological marker for the early diagnosis and evaluation of SSc-ILD patients,providing a new therapeutic target for the clinical treatment of SSc-ILD. |
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