肿瘤相关标志物在皮肌炎合并间质性肺病患者中的意义

杨嫄; 郝景程; 陈媛等

肿瘤相关标志物在皮肌炎合并间质性肺病患者中的意义

The Clinical Significance of Tumor-associated Antigens in Dermatomyositis Patients with Interstitial Lung Disease

摘要

摘要: 目的探讨肿瘤相关标志物与皮肌炎（dermatomyositis, DM）并发间质性肺病(interstitial lung disease, ILD)的关系，寻找临床中DM合并ILD的血清标志物，帮助判断病情，指导治疗。方法前瞻性纳入59例DM患者, 其中合并ILD患者30例，另有5例合并恶性肿瘤。测定血清转录中介因子1-γ（TIF1-γ）抗体以及肿瘤相关抗原（tumor-associated antigens，TAAs），分析肿瘤相关标志物与DM合并ILD的关系，并采用受试者工作特征（receiver operating characteristic, ROC）曲线分析单指标、多指标联合的诊断价值。结果59例DM中合并ILD与合并肿瘤相互独立。共11例血清TIF1-γ抗体阳性。在5例合并恶性肿瘤DM患者中，4例血清TIF1-γ抗体阳性，其诊断肿瘤灵敏度为36.36%，特异度为97.92%。而在30例DM合并ILD患者中，仅1例TIF1-γ抗体阳性(P=0.002)。DM合并ILD组中血清糖类抗原125(CA125)（P=0.018）、糖类抗原153(carbohydrate antigen-125,CA153)（P=0.014）、细胞角蛋白19片段(CYFRA21-1)增高（P=0.002），CYFRA21-1诊断ILD的ROC曲线下面积（AUC）为0.745（P=0.002），当最佳诊断点为3.58 ng/mL时，血清CYFRA21-1检测DM合并ILD的敏感性和特异性分别为60.71%和84%， CA125（21.5 U/mL）与CYFRA21-1（3.58 ng/mL）的联合诊断价值最高，AUC达0.801（P<0.001），但诊断点的敏感性和特异性未见明显提高（分别为64.29%和82.61%）。结论在DM合并ILD患者中，肿瘤相关抗原CA125、CA153、CYFRA21-1的血清水平升高提示DM合并ILD情况，尤其是CYFRA21-1，可以考虑作为DM合并ILD的较好的血清学指标。

Abstract: Objective To investigate the relationship between tumor related markers and the presence of interstitial lung disease (ILD) in dermatomyositis (DM) patients as well as potential serum markers for accompanied ILD. MethodsFifty-nine DM patients were included, including 30 patents with ILD. Serum level of anti-transcription intermediary factor1-γ (TIF1-γ) and tumor-associated antigens (TAAs) were detected to analyze the correlation of these markers with ILD. Meanwhile, the diagnostic value of these markers was evaluated by receive operating characteristic (ROC) curve analysis. ResultsWe found that there were 5 patients bearing malignancies, independent from the presence of ILD (P=0.024). Serum anti-TIF1-γ was positive in 4/5 DM patients with tumor, of which sensitivity and specificity were 36.36% and 97.92%, respectively. In contrast, only one case was found positive anti-TIF1-γ in 30 DM with ILD (P=0.002). carbohydrate antigen (CA)125, CA153, and cytokeratin-19 fragment (CYFRA21-1) were elevated in DM patients with ILD in compared to those without ILD. The area under curve (AUC) of CYFRA21-1 for the prediction of ILD was 0.745 (P=0.002). The optimal cut-off value was 3.58 ng/mL with a sensitivity of 60.71% and a specificity of 84.00%. The AUC in combination of CA125 and CYFRA21-1 could reach 0.801 (P<0.002) with a sensitivity of 64.29% and a specificity of 82.61%. ConclusionPresence of malignance and positive anti-TIF1γ could be the protective factors for ILD in DM. Elevated serum levels of CA125, CA153, CYFRA21-1 could indicate the accompanying ILD.

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