| Objective:To explore the prognostic value of chemokine CCL2(C-C motif)ligand 2,extracellular matrix proteins-1(ECM1)and GAP scores in bronchoalveolar lavage fluid(BALF)for IPF in the real world,and the correlation between them.Methods:The clinical data of 47 patients with IPF who were hospitalized in Gulou Clinical Medical College of Nanjing University of traditional Chinese medicine from January 2017 to December 2019 were retrospectively analyzed,and the clinical data of 10 outpatients(without other lung diseases or other organ diseases)who were hospitalized due to chronic cough(CC)were collected.The gender,age,forced vital capacity(FVC),diffusing capacity for carbon monoxide(DLCO)(except CC group),blood gas analysis and other indicators of the two groups were compared,and the levels of CCL2,interleukin-6(IL-6),IL-8,IL-1A,matrix metalloproteinase-9(MMP9),ECM1 in BALF were detected,To analyze its prognostic value for IPF patients,the difference of its level between different gap groups,the difference of survival time of patients and the correlation with gap score.Results:Compared with CC group,the oxygenation index(PaO2/FiO2)and FVC%in IPF group decreased,and the levels of CCL2,IL-6,IL-1a and ECM1 in BALF increased.Compared with CC group,there was no difference in lymphocytes,neutrophils and macrophages in BALF in IPF group.In terms of correlation,CCL2 was negatively correlated with FVC%and DLCO%in BALF,MMP9 was negatively correlated with DLCO%and ECM1 was negatively correlated with FVC%.Univariate Cox proportional hazards regression and Kaplan Meier survival analysis showed that FVC%,DLCO,CCL2 and ECM1 in BALF affected the prognosis of IPF patients.Further multivariate Cox regression analysis showed that FVC%and CCL2 in BALF were the main factors affecting the prognosis of IPF patients.Among them,the HR values of FVC%and DLCO%are less than 1,considering that they are positively correlated with the prognosis of patients in IPF group,while the HR values of CCL2 and ECM1 in BALF are greater than 1,considering that they are negatively correlated with the prognosis of patients in IPF group.And receiver operating characteristic curve(ROC)curve showed that when CCL2 level in BALF was greater than or equal to 363.74pg/ml,the mortality of patients increased;When the ECM1 level in BALF is greater than or equal to 66.55ng/ml,the mortality of patients increases.Then,according to the GAP score,IPF patients were staged.The results showed that in BALE,except for the unclear difference in the levels of CCL2 and ECM1 between stage Ⅰ and CC group,there were significant differences in the levels of CCL2 and ECM1 between stage Ⅱ and CC group,stage Ⅲ and CC group,and IPF group(stage Ⅰ,Ⅱ,Ⅲ).In terms of lung function,FVC%and DLCO%in phase Ⅱ and Ⅲ were significantly lower than those in phase I,and there was little difference in FVC%and DLCO%between phase Ⅱ and Ⅲ.Further survival analysis showed that the survival time of patients with stage Ⅱ and Ⅲ was significantly lower than that of patients with stage Ⅰ,but there was no significant difference between stage Ⅱ and Ⅲ.It was found that CCL2,ECM1 in BALF were positively correlated with GAP scores.Conclusion:This study verifies the efficacy of CCL2 level and GAP score in BALF in judging the prognosis of IPF.At the same time,it is the first time to find that ECM1 in BALF can predict the prognosis of IPF.It is also discussed that the levels of CCL2 and ECM1 in BALF are different in IPF patients with different GAP stages,and the levels of CCL2 and ECM1 in BALF are also positively correlated with GAP score. |
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