| Objectives:1.To explore the expression levels of SP-A and SP-D in BALF of patients with diffuse pulmonary lesions and the significance of disease identification.2.To explore the expression levels of SP-A and SP-D in BALF of patients with ILD to patients with disease the significance of the severity assessment.Methods:1.A total of 94 patients were selected from 2017.10 to 2019.10 who were diagnosed in the second hospital of Hebei Medical University with diffuse lesions of the two lungs and underwent bronchoalveolar lavage.Among them,46 were males and 48 were females.ILD group was 60 patients,16 patients in lung cancer group(all confirmed by pathological biopsy of lung tissue),18 patients in pneumonia group(all patients with pathogenic bacteria detected in sputum or bronchial secretions and improved imaging after anti-infective treatment).It is further divided into:(1)25 cases in the IIP group:13 cases of IPF,8 cases of IPAF,and 4 cases of rare IIP;(2)30 cases of the CTD-ILD group: 5 cases of SS-ILD,8 cases of RA-ILD,and 10 cases of PM/DM-ILD,7 cases of UCTD-ILD;(3)Granulomatous ILD group: 3 cases of Sarcoidosis;(4)Other types of ILD group: 2 cases of Pneumoconiosis.The arterial partial oxygen pressure and pulmonary function indexes at the time of admission were measured.,6-minute walking distance,lung high-resolution tomography(HRCT)imaging data,scoring lung HRCT,and performing electronic bronchoscopy on the patient,retaining BALF,and analyzing SP-A and SP-D,the expression level of BALF and its significance in disease identification.2.To analyze the correlation between the expression levels of SP-A and SP-D in BALF of ILD patients and lung function indexes,oxygenation index,lung HRCT score and 6-minute walking distance.Results:1.Analysis of SP-A and SP-D expression levels in BALF of pneumonia and lung cancer groups:1.1 The concentration of SP-A in BALF of patients with pneumonia and lung cancer was 110.48±11.32pg/ml,120.24±16.38pg/ml,and the SP-D concentration was 1839.67±183.211pg/ml,1808.48±163.15pg/ml.There was no significant difference in A and SP-D concentrations(P>0.05).1.2 The SP-A concentrations of adenocarcinoma,squamous cell carcinoma,and small cell carcinoma BALF in the lung cancer group were 123.60±18.93pg/ml,120.18±17.86pg/ml,113.60±9.86pg/ml,and the SP-D concentrations respectively were 1863.44 ± 184.13pg/ml,1813.73± 108.33pg/ ml,1693.31±128.34 pg/ml,respectively.There was no statistically significant difference in the concentrations of SP-A and SP-D between the three groups(P>0.05).2.Expression levels of SP-A and SP-D in BALF of ILD group:2.1 The SP-A and SP-D concentrations in BALF in the ILD group were 111.44 ±27.93 pg/ml and 1421.36±317.85 pg /ml,respectively.The SP-A concentration in BALF in ILD patients was not significantly different from the pneumonia and lung cancer groups(P>0.05),the SP-D concentration of patients with ILD was lower than that of patients with pneumonia and lung cancer,and the difference was statistically significant(P=0.000,P=0.000).2.2 The concentration of SP-A in BALF of each subgroup of IIP is different.The concentration of SP-A in BALF of IPF patients is lower than that of IPAF and other IIP patients.The difference is statistically significant(P=0.028 and P = 0.04,respectively).There was no significant difference in SP-D concentration in the BALF of the subgroup(P>0.05).2.3 There was no statistical difference in SP-A concentration in BALF Of SS-ILD,RA-ILD,PM/DM-ILD,and UCTD-ILD patients in each subgroup of CTD-ILD(P>0.05);there was a difference in SP-D concentration in each subgroup,and in BALF of patients in PM/DM-ILD group SP-D concentrations were lower than those in the UCTD-ILD,SS-ILD,and RA-ILD groups,and the differences were statistically significant(P=0.011,P=0.046,P=0.007,respectively).2.4 Granulomatous ILD(Sarcoidosis)and other ILD(Pneumoconiosis),there were no significant differences in SP-A and SP-D concentrations in BALF between two groups of patients(P>0.05),granulomatous ILD(Sarcoidosis),other ILD(Pneumoconiosis),the concentrations of SP-A and SP-D in BALF were higher than those in IIP and CTD-ILD subgroups,and the differences were statistically significant(both P=0.00).3.Correlation analysis of SP-A and SP-D expression levels in BALF with lung function,lung HRCT score,OI and 6-minute walking distance in patients with IIP,CTD-ILD,IPF and PM/DM-ILD:3.1 The concentration of SP-A in IIP patients was positively correlated with TLC%pre and DLCO%pre(respectively r=0.504,P=0.017: r=0.554,P =0.007),and negatively correlated with lung HRCT scores(r=-0.551,P=0.004).SP-D concentration was positively correlated with FEV1%pre and DLCO%pre(respectively r=0.412,P=0.046;r=0.509,P=0.016),and negatively correlated with the HRCT score(r=-0.613,P=0.001).3.2 SP-A concentration in BALF of CTD-ILD patients was positively correlated with TLC%pre(r=0.499,P=0.018).SP-D concentration is positively correlated with FVC%pre,DLCO%pre,and OI(respectively r=0.453,P=0.034;r=0.457,P=0.033,r=0.465,P=0.010),which was negatively correlated with lung HRCT scores(r=-0.777,P=0.000).3.3 In IPF,SP-A concentration was positively correlated with TLC%pre and DLCO%pre(respectively r=0.623,P=0.041;r=0.673,P=0.023),and was negatively correlated with lung HRCT scores(r=-0.733,P=0.004).SP-D concentration was positively correlated with FVC%pre,FEV1%pre(respectively r=0.752,P=0.003;r=0.660,P=0.014).3.4 In patients with PM/DM-ILD,SP-D levels in BALF were strongly negatively correlated with lung HRCT scores(r=-0.933,P=0.000),and positively correlated with FVC%pre,FEV1%pre,and DLCO%pre(respectively r=0.842,P=0.09;r=0.819,P=0.013,r=0.775,P=0.024),and SP-A has no correlation with lung HRCT scores,lung function,and 6-minute walking experiments.Conclusions:1.The expression levels of SP-A and SP-D in BALF are different in patients with different types of diffuse lung lesions,which can guide the diagnosis of diffuse lung lesions to a certain extent.2.The expression levels of SP-A and SP-D in BALF were related to lung function and HRCT score in IIP and CTD-ILD groups.The lower SP-A and SP-D concentrations in BALF of patients with IIP and CTD-ILD group were,the worse pulmonary function and pulmonary imaging performance were. |
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