小儿风湿病相关间质性肺疾病患者血清KL-6、LN、MMP-7 水平及其临床意义

Serum KL-6, LN, MMP-7 levels, and clinical significance in children with rheumatism-associated interstitial lung disease

摘要:

目的 探讨小儿风湿病相关间质性肺疾病患者血清涎液化糖链抗原-6（KL-6）、层粘连蛋白（LN） 及基质金属蛋白酶-7（MMP-7）水平及其临床意义。方法 回顾性分析2017年5月—2019年5月河北医科大学 附属河北省儿童医院收治的风湿病患儿78例作为风湿病组，选取同期该院收治的风湿病相关间质性肺疾病患儿60 例作为间质性肺疾病组，同期该院体检的72例健康小儿作为健康组。比较3组血清KL-6、LN、MMP-7水平； 比较风湿病相关间质性肺疾病活动期与非活动期患儿血清KL-6、LN、MMP-7水平；比较风湿病相关间质性肺 疾病活动期与非活动期患儿肺活量（VC）、用力肺活量（FVC）、第1秒钟用力呼吸容积（FEV1）及肺一氧化碳弥散 量（DLCO）；分析风湿病相关间质性肺疾病患儿血清KL-6、LN、MMP-7水平与VC、FVC、FEV1、DLCO的相 关性。结果 间质性肺疾病组和风湿病组血清KL-6、LN、MMP-7水平高于健康组（P <0.05），且间质性肺疾 病组高于风湿病组（P <0.05）。风湿病相关间质性肺疾病活动期患儿血清KL-6、LN、MMP-7水平高于非活动 期（P <0.05）。风湿病相关间质性肺疾病患儿血清KL-6、LN、MMP-7水平分别与类风湿关节炎疾病活动度评 分（DAS28） 呈正相关（r =0.749、0.826 和0.728，均P =0.000）。风湿病相关间质性肺疾病活动期患儿VC、 FVC、FEV1、DLCO低于非活动期（P <0.05）。风湿病相关间质性肺疾病患儿血清KL-6、LN、MMP-7水平分 别与VC、FVC、FEV1、DLCO 呈负相关（KL-6：r =-0.846、-0.829、-0.715 和-0.731， 均P =0.000；LN： r =-0.853、-0.796、-0.752 和-0.814，均P =0.000；MMP-7：r =-0.827、-0.814、-0.722和-0.743，均P = 0.000）。结论 风湿病和风湿病相关间质性肺疾病患儿血清KL-6、LN、MMP-7水平升高，检测上述指标有助 于早期发现风湿病和风湿病相关间质性肺疾病。风湿病相关间质性肺疾病患儿血清KL-6、LN、MMP-7水平与 肺功能指标相关。

Abstract:

Objective To explore the serum levels of sputum glycosylated antigen-6 (KL-6), laminin (LN), and matrix metalloproteinase-7 (MMP-7) in children with rheumatism-related interstitial lung disease (JIA-ILD) and their clinical significance. Methods The data of 78 children with simple rheumatism (JIA) admitted to the hospital from May 2017 to May 2019 was retrospectively analyzed, recorded as RA group; and the data of 60 cases of JIAILD in the same period of the hospital was retrospectively analyzed, recorded as JIA-ILD group; the data of 72 healthy children who were examined in the hospital at the same time were retrospectively analyzed, recorded as healthy group. The levels of serum KL-6, LN, and MMP-7 in the RA group, JIA-ILD group, and healthy group were compared; serum KL-6, LN, and MMP-7 levels were compared between the active periods and inactive periods of JIA-ILD; indexs of lung function vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and carbon monoxide diffusion capacity (DLCO) were compared between the active periods and inactive periods of JIA-ILD; the correlation between serum KL-6, LN and MMP-7 levels and indexs of lung function VC, FVC, FEV1, and DLCO in children with JIA-ILD was analyzed. Results The levels of serum KL-6, LN, and MMP-7 in JIA-ILD group were higher than those in healthy group (P < 0.05); the levels of serum KL-6, LN and MMP-7 in the JIA-ILD group were higher than those in the JIA group (P < 0.05); the levels of serum KL-6, LN and MMP-7 in children with JIA-ILD during active period were higher than those during the inactive period (P < 0.05). The serum KL-6 (r = 0.749), LN (r = 0.826), and MMP-7 (r = 0.728) levels in children with JIA-ILD were positive correlation correlated with DAS28 scores, respectively (all P = 0.000. The lung functional indicators VC, FVC, FEV1, and DLCO in JIA-ILD during active period were lower than those during the inactive period (P < 0.05). The serum levels of KL-6, LN, and MMP-7 in children with JIA-ILD were negatively correlated with indexs of lung function VC, FVC, FEV1 and DLCO, respectively ( KL-6 : r = -0.846, -0.829, -0.715, and -0.731, all P = 0.000; LN: r = -0.853, -0.796, -0.752, and -0.814, all P = 0.000; MMP-7 : r = -0.827, -0.814, -0.722, and -0.743, all P = 0.000). Conclusion Serum levels of KL-6, LN, and MMP-7 in children with RA and JIA-ILD are increased. They are helpful for early detection of lesions with JIA and JIA-ILD and have a certain promoting effect on JIA-ILD activity. The serum levels of KL-6, LN, and MMP-7 in children with JIA-ILD are related to lung function indicators.