ABSTRACT
Interstitial lung diseases (ILDs) are a diverse group of pulmonary disorders characterized by various patterns of inflammation and fibrosis in the interstitium of the lung.The underlying pathogene sis of ILDs is complex and associated with multiple rheumatologic conditions,such as systemic sclerosis,rheumatoid arthritis,pollymyositis and dermatomyositis,Sjt(o)gren's syndrome,and systemic lupus erythematosus.As the disease progresses,excessive pulmonary fibrosis impairs alveolar gas exchange and damages pulmonary function.The common methods to diagnose ILDs,such as clinical manifestations,pulmonary function test,and radiological examinations are not specific for ILDs and not able to diagnose ILDs at the early stage due to their low sensitivity.So,the easy way is important to diagnose ILDs.One important biomarker for ILDs is the high-molecular-weight glycoprotein,Krebs von den Lungen-6 (KL-6).KL-6 encoded by the MUC1 gene is a mucin-like glycoprotein with high molecular weight and expressed predominantly on the cell surface of type Ⅱ alveolar epithelial cells,and is detectable in the serum of patients with ILDs.We here report a case of ILDs associated with dermatomyositis and secondary Sj(o)gren's syndrome.A 60-year-old woman was admitted to our hospital with the chief complaints of debilitation,dry mouth,dyspnea and astasia.ILDs associated with dermatomyositis and secondary Sj(o)gren's syndrome was diagnosed clinically when the following criteria were satisfied:(1) development of dyspnea within 2 months of presentation,(2) pulmonary dispersion dysfunction,(3) bilateral infiltrative shadows on chest high resolution computed tomography (HRCT).She was treated with prednisone 50 mg/d prior to admission,but the result of therapy was not good.In our hospital she was treated with intravenous methylprednisolone and cyclophosphamide and oral hydroxychloroquine sulfate.Subsequently,her serum KL-6 levels gradually decreased after treatment,pulmonary diffuse function improved,and the improvement in the clinical manifestation and HRCT findings were observed.Nevertheless,the combination treatment of glucocorticoid and cyclophosphamide had contributed to the favourable outcomes.In conclusion,detection of serum KL-6 levels in ILDs associated with connective tissue diseases may be beneficial to making a definitive diagnosis,predicting the prognosis and monitoring the disease activity,which would be of great help in clinical practice.However,a well-designed clinical study with more patients and a longer follow-up period are required to arrive at a more conclusive judgment on the role of serum KL-6 in patients with ILDs.
ABSTRACT
Objective To investigate the association of genetic polymorphisms of intercellular adhesion molecule 1 (ICAM-1) with diabetic peripheral neuropathy (DPN). Methods A total of 607 type 2 diabetes patients from the Affiliated Hospital of Weifang Medical University were enrolled in this study between June 2013 and December 2014. Rs5498 (A/G K469E) and rs1799969 (G/A R241G) in the ICAM-1 gene were genotyped by using TaqMan allelic discrimination in 295 patients with DPN and 312 subjects without DPN. The distribution of these two SNPs and the genetic influence of ICAM-1 gene polymorphisms on the development of DPN were conducted. Results Genotype distributions of both SNPs were coincided with Hardy-Weinberg equilibrium in the two groups. SNP rs1799969 (G/A R241G) in the ICAM-1 gene showed a high GG genotypic frequency at 96.8%(non DPN) and 99.0%(DPN) respectively. SNP rs5498 (A/G K469E) represented AA and AG genotypes. The values were AA 48.7%/AG 39.4%in non DPN group and AA 51.5%/AG 41.7%in DPN group. There were no significant differences in genotypic distributions and allele frequencies of SNPs rs1799969 (G/A R241G) and rs5498 (A/G K469E) between the patients with DPN group and patients without DPN group (P>0.05). The dominant(AA+AG)/GG and additive (GG/AA) models of rs5498 (A/G K469E) were associated with higher risk of DPN (ORadjusted=1.585, 1.575 respectively, P<0.05). To carry A allele was related to the susceptibility of DPN. There was no such association in genetic models of rs1799969 (G/A R241G) and DPN pathogenesis. Conclusion The present study provides evidence that SNP rs5498 E469K (A/G) in the ICAM-1 gene is associated with susceptibility of DPN, and the carrying A allele appears to be a risk of DPN.