癌胚抗原和抗mda5抗体在多发性肌炎/皮肌炎相关快速进展间质性肺病中的诊断意义

Medicina clinica (English ed.) Pub Date : 2025-09-01 DOI:10.1016/j.medcle.2025.107048

Pengfang Tang, Wengting Hong, Binbin Chen, Hongying Shi

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引用次数: 0

摘要

目的探讨肺癌相关生物标志物与多发性肌炎/皮肌炎（PM/DM）合并间质性肺炎的关系，以确定PM/DM快速进展性间质性肺炎（RP-ILD）的血清学标志物。方法本研究为对照研究，收集福建医科大学附属第二医院2019年8月至2024年1月的临床和实验室数据。评估的肿瘤标志物包括癌胚抗原（CEA）、细胞角蛋白-19片段（CYFRA21-1）和神经元特异性烯醇化酶（NSE）。本研究旨在比较具有不同特征的PM/DM患者的临床指标和肺癌生物标志物的差异。数据分析采用Spearman秩相关分析、logistic回归分析和受试者工作特征（ROC）曲线分析。结果共纳入130例患者，其中99例（76.15%）诊断为间质性肺疾病（ILD）。其中73例为慢性ILD， 26例为RP-ILD。其余31例（23.85%）无ILD。在临床症状方面，与慢性ILD组和非ILD组相比，RP-ILD组的Gottron's体征和呼吸短促的发生率明显更高。在临床标志物方面，RP-ILD患者的血清铁蛋白、CEA和CYFRA21-1水平远高于慢性ILD （C-ILD）和非ILD （N-ILD）患者。相反，与其他组相比，RP-ILD组的氧合指数、强制肺活量、一氧化碳扩散能力和CD3+CD4+ T细胞计数显著降低。抗黑色素瘤分化相关基因5 （MDA5）抗体的存在、血清CEA水平、CD3+CD4+ T细胞比率和氧合指数与PM/DM合并RP-ILD之间存在显著相关性。结合血清CEA水平和抗mda5抗体对PM/DM-RPILD的诊断价值最高，敏感性为88.9%，特异性为81.6%，曲线下面积为0.923 （P < 0.001）。结论肺癌相关生物标志物（尤其是CEA）的血清浓度升高以及抗mda5抗体的存在与PM/DM合并RP-ILD有显著相关性。这种生物标志物的组合可以增强PM/DM患者RP-ILD亚型的识别。

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Diagnostic significance of carcinoembryonic antigen and anti-MDA5 antibodies in polymyositis/dermatomyositis-associated rapidly progressive interstitial lung disease

Objectives

To explore relationship between lung cancer-related biomarkers and polymyositis/dermatomyositis (PM/DM) complicated with interstitial pneumonia, so as to identify serological markers for PM/DM rapidly progressing interstitial pneumonia (RP-ILD).

Methods

This study was a control study in which clinical and laboratory data were collected from the Fujian Medical University Affiliated Second Hospital between August 2019 and January 2024. The tumor markers assessed included carcinoembryonic antigen (CEA), cytokeratin-19 fragment (CYFRA21-1), and neuron-specific enolase (NSE). The study aimed to compare clinical indicators and lung cancer biomarker differences among patients with PM/DM exhibiting varying characteristics. Data analysis was conducted using Spearman's rank correlation, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis.

Results

The study included a total of 130 patients, of whom 99 (76.15%) were diagnosed with interstitial lung disease (ILD). Among these, 73 patients had chronic ILD, while 26 exhibited RP-ILD. The remaining 31 individuals (23.85%) did not have ILD. In terms of clinical symptoms, the incidence of Gottron's sign and shortness of breath was significantly higher in the RP-ILD group compared to the chronic ILD and non-ILD groups. In terms of clinical markers, RP-ILD patients had much higher levels of serum ferritin, CEA, and CYFRA21-1 than those with chronic ILD (C-ILD) and non-ILD (N-ILD). Conversely, the RP-ILD group showed significantly reduced values for the oxygenation index, forced vital capacity, carbon monoxide diffusion capacity, and CD3⁺CD4⁺ T cell counts compared to the other groups. A significant correlation was observed between the presence of anti-melanoma differentiation-associated gene 5 (MDA5) antibodies, serum CEA levels, CD3⁺CD4⁺ T cell ratio, and oxygenation index with PM/DM complicated by RP-ILD. The combination of serum CEA levels and anti-MDA5 antibodies demonstrated the highest diagnostic value for PM/DM-RPILD, demonstrating a sensitivity of 88.9% and a specificity of 81.6%, with an area under the curve of 0.923 (P < 0.001).

Conclusions

Elevated serum concentrations of lung cancer-associated biomarkers, notably CEA, alongside the presence of anti-MDA5 antibodies, exhibit a significant correlation with PM/DM complicated by RP-ILD. This combination of biomarkers could enhance the identification of RP-ILD subtypes in PM/DM patients.

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Medicina clinica (English ed.)

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