| Objective:By analyzing the expression levels of serum IL-27 and KL-6 in patients with CTD-ILD,and exploring their value in the diagnosis of CTD-ILD,it provides a theoretical basis for the diagnosis and treatment of the disease in clinical work.Methods:Prospectively collected clinical data from the patients diagnosed with connective tissue disease-associated interstitial lung disease and connective tissue disease in the Department of Respiratory and Rheumatology,Second Affiliated Hospital of Kunming Medical University from April 1,2018 to December 31,2018.Among them,26 patients diagnosed with connective tissue disease-associated interstitial lung disease were the experimental group(CTD-ILD group),including 7 cases of rheumatoid arthritis-associated interstitial lung disease,2 cases of Sjogren's syndrome-associated interstitial lung disease,6 cases of ANCA-associated vasculitic interstitial lung disease,8 cases of systemic sclerosis-associated interstitial lung disease,and 3 cases of dermatomyositis-associated interstitial lung disease;33 cases diagnosed with connective tissue disease patients were the control group(CTD group),including 13 cases of rheumatoid arthritis,9 cases of Sjogren's syndrome,8 cases of systemic sclerosis,and 3 cases of dermatomyositis.At the same time,we selected 16 case of healthy adult without interstitial lung disease,connective tissue disease history and family history,and all of them were non-smokers as the blank control group(normal group);the clinical data included:(1)gender,age,smoking history,serum IL-27 and KL-6 in the three groups;(2)laboratory test indicators completed within 24 hours after admission:blood routine(WBC,NEUT%,LYMPH%,MONO%,EO%,BASO%,NEUT#,LYMPH#,MONO#,EO#,BASO#,etc.),acute infection index(PCT,IL-6,hs-CRP),ESR,serum immunoglobulin(IgG,IgA,IgM).By analyzing the expression levels of the above indicators in patients with connective tissue disease-associated interstitial lung disease,we initially explored the diagnostic value of serum IL-27 and KL-6 for this disease.Results:1.There was a statistically significant difference in age and sex ratio between the three groups(P<0.05).2.In the blood routine of CTD-ILD group and CTD group,WBC,LYMPH%and NEUT#of CTD-ILD group were respectively(9.18±2.74)×109/L,(20.72±8.89)%,(6.69±2.86)×109/L;WBC,LYMPH%and NEUT#of the CTD group were respectively(7.28±3.12)×109/L,(26.01±10.29)%,(4.88±2.69)×109/L.There were significant differences in WBC,LYMPH%,and NEUT#(P<0.05)and no statistical significance in other blood routine indicators(P>0.05)between the two groups.3.There were no significant differences in PCT,IL-6,hs-CRP and ESR between CTD-ILD group and CTD group(P>0.05).4.In the immunoglobulin of CTD-ILD group and CTD group,the IgA of CTD-ILD group was(3.89±3.14)g/L,and the IgA of CTD group was(2.36±1.02)g/L.There was a statistically significant difference in IgA between the two groups(P<0.05)and no significant difference in IgG and IgM(P>0.05).5.The serum IL-27 concentration in the CTD-ILD group,CTD group,and normal group were respectively(55.34±20.75)pg/ml,(43.68±18.14)pg/ml,and(38.79±15.68)pg/ml.One-way analysis of variance between the three groups showed statistically significant differences(P<0.05).Further comparison between groups showed that the serum IL-27 concentration in the CTD-ILD group was significantly higher than that in the CTD group and the normal group(P<0.05),and there was no significant difference in serum IL-27 between the CTD group and the normal group(P>0.05).6.The serum KL-6 concentration in the CTD-ILD group,CTD group,and normal group were respectively(4.30±1.23)ng/ml,(3.58±1.27)ng/ml,and(2.43±1.45)ng/ml.One-way analysis of variance between the three groups showed statistically significant differences(P<0.01).Further comparison between the groups showed that the serum KL-6 concentration in the CTD-ILD group and the CTD group were significantly higher than that in the normal group(P<0.01),further more the serum KL-6 concentration in the CTD-ILD group was significantly higher than that in the CTD group(P<0.05).7.In the correlation analysis,WBC,NEUT#,IgA,IL-27,and KL-6 were associated with CTD-ILD.8.In the ROC curve of IL-27 and KL-6 for diagnosis of CTD-ILD,the AUC was 0.659,0.664,and the 95%CI was(0.517-0.800),(0.525-0.803),respectively.The accuracy of these two indicators for the diagnosis of CTD-ILD alone is low.The diagnostic thresholds of IL-27 and KL-6 judged by the Yoden index were 50.86pg/ml and 4.26ng/ml,respectively.At this critical value,the sensitivity,specificity,positive predictive value and negative predictive value of CTD-ILD were 53.85%,69.70%,58.33%,and 65.71%,respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of KD-6 for diagnosis of CTD-ILD.They were 61.54%,69.70%,61.54%,and 69.70%,respectively.Although the sensitivity of the two indicators combination was reduced(34.62%),the specificity was significantly increased(90.91%).Conclusions:1.WBC,NEUT#,IgA,IL-27,KL-6 are associated with CTD-ILD.2.The diagnostic accuracy of serum IL-27 and KL-6 for CTD-ILD alone is low,but the combined detection of the two indicators may have certain value in the diagnosis of CTD-ILD. |
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