The Correlative Research And Clinical Observation About Tumor Markers And Pulmonary Interstitial Fibrosis

Objective:Evaluate the tumor markers’ levels of IPF patients.Compare the levels of serum tumor markers between patients with idiopathic pulmonary fibrosis(IPF)and others with chronic obstructive pulmonary disease-associated interstitial lung disease(COPD-ILD)or connective tissue diseases-associated interstitial lung disease(CTD-ILD).Explore the relationship between serum tumor markers and IPF to provide references for clinical application.Methods: Clinicl data of 101 confirmed IPF patients admitted in the First and Second Affiliated Hospital of Dalian Medical University between January 2011 and December 2015,were retrospetively analyzed.Serum CEA、CYRA21-1 and CA19-9 of confirmed lung adenocarcinoma(n=111),chronic obstructive pulmonary disease-associated interstitial lung disease(COPD-ILD)(n=109),connective tissue diseases-associated interstitial lung disease(CTD-ILD)(n=94)patients and healthy(n=82),in the same period,were analyzed as controls.There was no evidence of intentional,liver,kidney,gastrointestinal cancer of all the study participants and except lung adenocarcinoma group;there was no evidence of lung cacer of other groups.Collect the blood gas analysis and lung function parameters of IPF patients,including forced vital capacity(FVC),forced vital capacity % of predicted value(FVC%pred),diffusing capacity of carbon monoxide(DLCO),diffusing capacity of carbon monoxide % of predicted value(DLCO%pred).The reference range for CEA was defined in 0-5ng/ml.The reference range for CYFRA21-1 、 CA19-9 were defined in 0-3.3ng/ml and 0-27U/ml.If serum tumor markers concentration were higher than the upper limit of the normal range,we difined it positive and if it was in normal range,we defined it negative.Positive rate(%)= the number of cases with elevated tumor markers/ the number of total cases.The rank sum test was utilized for evaluating the difference of tumor markers levels between IPF and other groups.The correlations between tumor markers and lung function parameters and blood gas analysis,were evaluated by Spearman’s correlation.Results:1.The positive rate of serum CEA and CA19-9 in IPF patients were 48.5% and 51.2%,and were significantly higher than the patients with COPD-ILD、CTD-ILD and healthy.The positive rate of serum CYFRA21-1 in IPF patients was 71.7% and was significantly higher than the patients with COPD-ILD and healthy,but compared with the patients with CTD-ILD was similarly.2.The CEA and CA19-9 levels of IPF patients were 4.64(2.98,7.05)ng/ml and 25.80(12.35,74.88)U/ml,and were significantly higher than the patients with COPD-ILD、CTD-ILD and healthy.The CYFRA21-1 levels of IPF patients was 4.49(3.21,6.09)ng/ml,was significantly higher than the patients with COPD-ILD and healthy,but compared with the patients with CTD-ILD was similarly.But the CEA levels of IPF was significantly lower than lung adenocarcinoma,and the difference was statistically significant.3.The maximum values of tumor markers in every groups(95 percentile,the concentration of the tumor markers of 95% patients were lower than this number): the maximuns of CEA、CYFRA21-1 and CA19-9 in IPF groups were 12.54ng/ml、12.08ng/ml and 251.85U/ml;the maximuns of CEA、CYFRA21-1 and CA19-9 in COPD-ILD groups were 7.3ng/ml、5.84 ng/ml and 34.7U/ml;the maximuns of CEA、CYFRA21-1 and CA19-9 in CTD-ILD groups were 10.95ng/ml 、 10.40ng/ml 、140.0U/ml.4.According to the concentration of serum CEA,the patients IPF can be divided into two groups.The PaO2、FVC%pred and DLCO%pred was significantly lower in patients with CEA concentration ≥5ng/ml compared with patients with CEA concentration < 5ng/ml.5.There was asignificant negative correlation bewteen serum CYFRA21-1 concentration and FVC% as well as beteen serum CA19-9 concentration and DLCO%pred.Conclutions:1.The rise of the serum tumor markers in IPF patients was a common phenomenon.In the clinic,when the CEA concentration is less than 12.54ng/ml,it may be associated with IPF itself and when it is higher than the scope,we should be highly ulert to the likehood of lung cancer.2.Difference of the tumor markers levels between IPF and COPD-ILD、CTD-ILD might be an underlying tip to identify IPF and COPD-ILD or CTD-ILD.3.The degree of serum tumor markers increases was associated with the severity of disease.