肿瘤标志物在类风湿性关节炎伴间质性肺病中的临床意义

摘要

目的 探讨肿瘤标志物在类风湿性关节炎伴间质性肺病(RA-ILD)中的临床意义.方法 收集2008年1月至2011年1月住院的82例类风湿关节炎患者.根据是否伴有间质性肺病,将其分为RA-ILD组(38例)和RA组(44例),比较两组血清肿瘤标志物癌胚抗原(CEA)、糖蛋白抗原15-3(CA15-3)、糖蛋白抗原19-9(CA19-9)水平、抗环瓜氨酸肽(CCP)抗体水平和肺功能包括用力肺活量(FVC)、第1秒用力呼气量(FEV1)、一氧化碳弥散量(DL)占预计值百分比,分析两组患者肿瘤标志物表达差异以及RA-ILD组肿瘤标志物与肺功能、抗CCP抗体相关性.结果 RA-ILD组外周血CEA、CA15-3、CA19-9水平均明显高于RA组(均P＜0.01);RA-ILD组FVC、FEV1和DLco占预计值百分比均明显低于RA组(均P＜0.01),但RA-ILD组抗CCP抗体水平与RA组比较差异无统计学意义(P ＞0.05).RA-ILD组CEA水平与FVC、FEV1和DLco呈负相关(r=-0.499、-0.576、-0.512,均P＜0.01),但CEA、CA15-3和CA19-9均与抗CCP抗体无相关性(r=-0.192、-0.264、-0.268,均P ＞0.05).结论 肿瘤标志物CEA、CA15-3和CA19-9在RA-ILD中表达升高,CEA可能反应RA-ILD肺间质受损的严重程度,而不是关节损害的严重程度.%Objective To assess the clinical significance of tumor markers (TMs) in rheumatoid arthritis (RA) with interstitial lung diseases (ILD). Methods Eighty-two RA inpatients were admitted in Hangzhou First People's Hospital from January 2008 to January 2011; among whom 38 were complicated by interstitial lung diseases (RA-ILD). Tumor markers (CEA, CA15-3, CA19-9), pulmonary function indexes (FVC, FEVi, DLco) and anti-cyclic citrullinated peptide antibody (anti-CCP) levels were measured in all patients. Correlation between TMs and pulmonary function indexes, level of anti-CCP antibody was analyzed by Spearman rank correlation. Results Serum levels of CEA, CA15-3 and CA19-9 in RA-ILD group were significantly higher than those in RA group (P<0.01). The percentage of predicted value for FVC, FEV1 and DLco was significantly decreased in RA-ILD group than that in RA group (P<0.01). There was no significant difference in anti-CCP levels between two groups ( P >0.05). Serum CEA level was negatively correlated with FVC (r=-0.499, P<0.01), FEV1(r=-0.576, P<0.01) and DLco (r=-0.512, P<0.01) in RA-ILD patients. There were no correlation of CEA, CA15-3 and CA19-9 levels with anti-CCP antibody (r=-0.192, -0.264, -0.268,respectively, P >0.05). Conclusion The serum tumor marker (CEA, CA15-3 and CA19-9) levels are increased in RA-ILD. CEA levels may reflect the decrease of lung function in RA-ILD, not the severity of joint lesion.