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Objective:To evaluate the prognostic value of extravascular lung water index (EVLWI) , soluble intercellular adhesion molecule-1(sICAM-1) and Krebs yon den lungen-6 (KL-6) in severe pneumonia patients with Severe Acute Respiratory Syndrome (ARDS).Methods:A prospective study was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from October 2017 to February 2020. The study included 65 severe pneumonia patients with ARDS, who was performed by measurement of pulse index continuous cardiac output and survived more than 3days after admission. The Extravascular Lung Water Index (EVLWI) , sICAM-1, KL-6 and Oxygenation Index(OI) on 1st, 3rd and 5th day were detected. APACHEⅡ score, patient survival events (days) and survival outcome were recorded. Correlation analysis between EVLWI, sICAM-1, KL-6 and OI was performed on the 1st, 3rd and 5th day after admission. Independent risk factors of mortality in severe pneumonia patients with ARDS were analyzed by multiple logistic regression. Receiver operating characteristic curve was drawn, and the prognostic value of each parameter was assessed finally.Results:The PCT, EVLWI, sICAM-1, KL-6 and APACHEⅡ score in the death group were significantly higher than those in the survival group ( P<0.05) at RICU admission, and the length of RICU stay was significantly shorter than that in the survival group ( P<0.05), while differences in other clinical characteristics between two groups were not statistically significant ( P>0.05) . These parameters including levels of EVLWI, sICAM-1, KL-6, Procalcitonin and APACHE Ⅱscore in the death group were significantly higher than those in the survival group on the 1st, 3rd and 5th day ( P<0.05), whereas the OI was significantly lower than that of the survival group on the 3rd and 5th day ( P<0.05). Logistic regression analysis showed that EVLWI, sICAM-1, KL-6 level were significantly related with the mortality of these patients. The levels of sICAM-1, kl-6 and EVLWI on 1st, 3rd and 5th day after RICU admission showed a significant negative correlation with OI ( P<0.001). Whereas, The levels of sICAM-1, kL-6 on 1st, 3rd and 5th day showed a significant positive correlation with EVLWI ( P<0.001). The sensitivity and specificity of sICAM-1, KL-6 combined with EVLWI in prognosis evaluation on 1st, 3rd and 5th day were 75.0%, 84.4%, 85.0%, 66.7%, 80.0%, 86.7%, respectively. The AUC was 0.864, 0.881, 0.892 on 1st, 3rd and 5th day, respectively ( P<0.001), which had a better prognostic value than each of them. Conclusions:EVLWI, sICAM-1 and KL-6 were independent risk factors for the prognosis of severe pneumonia patients with ARDS. The combination of EVLWI, sICAM-1 and KL-6 might be important in early predicting the prognosis of the 28d mortality.
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Objective@#To investigate the effects of long-term exposure to silica dust on serum CC16 and KL-6 levels.@*Methods@#The patients with stage I silicosis who were hospitalized in our hospital from April 2016 to April 2017 were treated as silicosis group. The silica dust exposed workers without silicosis who were taken the physical examination in our hospital were taken as a dust-exposed group. The healthy control group comes from in the same period of community physical examination did not touch the dust. The levels of CC16 and KL-6 in serum of all subjects were determined by enzyme-linked immunosorbent assay (ELISA) , and the levels of CC16 and KL-6 in serum were compared in three groups.@*Results@#Compared with the control group, the serum levels of CC16 in the silicosis group (P<0.01) and the dust-exposed group (P<0.01) were significantly lower. Compared with the control group, the level of serum KL-6 in the silicosis group was significantly decreased (P<0.01) compared with the control group, while the level of KL-6 in the serum of the dust-exposed group was significantly increased (P<0.01) . The ROC area of CC16 for diagnosis of silicosis was 0.92 (P<0.01) , with a sensitivity of 81.37%, specificity of 92.63% and Kappa value of 0.74.@*Conclusion@#Long-term exposure to silica dust may lead to a decrease in serum CC16 levels. Reduced serum CC16 levels may be useful in identifying the diagnosis of silicosis.
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Objective@#To establish an animal model of hard metal lung disease (HMLD) in rats, and to screen the indications for diagnosis of HMLD.@*Methods@#The rats were randomly divided into 5 groups, each group included 8 rats: saline group, pure cobalt group, pure tungsten carbide group, silica group and hard metal (HM) group. 10 mg subjects were administered in each group by using the pulmonary endotracheal tube. After 8 week, the lung CT scan and lung tissue pathology were observed, the serum and bronchoalveolar lavage fluid (BALF) were collected for KL-6, TGF-beta1 and TGF-beta2.@*Results@#The lung tissue structure of HM group was destroyed, a large number of nuclear giant cells and epithelial like cells appeared in the stroma, and uncommon CT scan images appeared in the lung. KL-6, TGF-beta1, TGF-beta2 expression in each group was not the same, the difference was statistically significant (P<0.05) . The expression of KL-6 and TGF-beta1 in serum was not identical in all the groups, the difference was statistically significant (P<0.05) . The expression of TGF-beta2 had no significant difference between the groups (P>0.05) .@*Conclusion@#Rats can be successfully established HMLD model, rats in vivo lung CT scan images appear abnormal, which are provided with assistant diagnostic value for HMLD. The expression of KL-6 and TGF-beta2 in serum and BALF on HMLD rats are not highly specific, and TGF-beta1 has reference value in the rat HMLD auxiliary diagnosis.
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Objective To explore the irradiation-increased krebs yon den lungen-6 (KL-6) in predicting radiation pneumonitis (RP) after lung cancer radiotherapy.Methods A total of 87 hospitalized patients with Ⅰ-Ⅲ stages of lung cancer from June 2015 to December 2015 were followed up,and their clinicopathological data and serum KL-6,transforming growth factor-beta 1 (TGF-β1)and lactate dehydrogenase (LDH)before and 3 months after radiotherapy were analyzed to determine their role in predicting RP induction in lung cancer.Results Among the 87 lung cancer patients based on clinical symptoms and chest CT,13 patients were diagnosed with ≥2 grape RP.Before radiotherapy,the average levels of serum KL-6 were (247 ± 105.44) U/ml in 13 patients with ≥ 2 grape RP and (209 ± 71.09) U/ml in 74 cases 0/1 grape RP,respectively.Within 3 months after radiotherapy,the highest level of KL-6 approached to (456 ± 202.84) and (222 ± 80.42) U/ml with increase ratios of 2.01 ± 1.04 and 1.13 ± 0.60 in the ≥2 grape RP and 0/1 grape RP,respectively.The difference of KL-6 levels between these two groups was significant (t =2.901,P ＜ 0.005).While the levels of TGF-β1 and LDH did not change.ROC analysis showed that the sensitivity of the ratio of serum KL-6 increased after radiotherapy was 0.923％ and the specificity was 0.851％ at 1.435 as the critical value.Furthermore,the multi-variate logistic regression analysis showed that the ratio of KL-6 increased as an independent risk factor of ≥ 2 grade RP in lung cancer (OR =12.886,95％ CI =3.372-49.247,P =0.002).Conclusions The increased ratio (≥ 1.435) of KL-6 is closely correlated with the ≥2 grape RP in lung cancer,which could be used as a predictor of ≥2 grape RP in lung cancer.
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Interstitial lung disease represents a group of diffuse pulmonary diseases that mainly affects pulmonary mesenchyme and alveolar spaces,resulting in loss of alveolar-capillary functions.It is also a common complication or an important factor that influences the prognosis of rheumatoid arthritis,dermatomyositis,systemic sclerosis.Searching for the biomarkers for the early diagnosis of the disease and/or indicative of the activity of the condition has been a subject of active investigations.KL-6,expressed on type Ⅱ pneumocytes,is seen as the most promising biomarker for the diagnosis of the disease.This review summarizes the recent researches about the use of KL-6 in the diagnosis and treatment of interstitial lung disease.
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Objective To investigate the significance of serum krebs Yon den lungen-6(KL-6), surfactant protein A(SP-A), surfactant protein D(SP-D )and matrix metalloprotease 7(MMP-7) in the diagnosis of idiopathic pul-monary fibrosis (IPF) and its relationship with pulmonary function .Methods Serum levels of KL-6, SP-D, SP-A and MMP-7 were detected by ELISA in 38 patients with IPF and serum from 38 patients with pneumonia and 38 normal controls.Serum levels of markers were further analyzed by operating characteristic curve receiver (ROC), from which the ideal level of each serum marker was obtained , and the follow-up of 6 months in patients with IPF . Explore the significance of the diagnosis of IPF and its correlation with pulmonary function .Results The expres-sion of MMP-7, SP-A, SP-D and KL-6 in serum of IPF patients was higher than that in the control group and healthy control group ( P<0.05) .The optimal cutoff value of KL-6 was 723.0 U/ml, SP-A was 67.2 ng/ml, SP-D was 98.1 ng/ml, and MMP-7 was 10.1 ng/ml.The sensitivity of KL-6 was 71.1% and 98.7%, SP-A was 81.6%and 97.4%, SP-D was 81.6%and 97.4%, MMP-7 was 68.4%and 98.7%.The sensitivity of combined KL-6, SP-A, SP-D and MMP-7 four serum markers was 100%, compared with a single serum index , the P value was less than 0.05, with statistical significance .IPF patients serum SP-A, MMP-7 and forced vital capacity within 6 months were significantly correlated(r1 =-0.574,P1 <0.001;r2 =-0.465,P2 =0.003).Conclusion KL-6, SP-A, SP-D and MMP-7 were highly expressed in serum of patients with IPF , and in the diagnosis of IPF , com-bined detection of 4 serum markers can improve the early diagnosis of IPF patients .Combined serum SP-A and MMP-7 levels can improve the accuracy of the IPF patients with pulmonary function changes , the prediction of dis-ease progression has a certain significance .
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Objective To investigate the clinical value of KL-6 mucin in differential diagnosis of benign and malignant obstructive jaundice.Methods A total of 41 patients with malignant tumors and 15 with benign lesions were recruited in the study.KL-6 mucin levels of bile and serum were measured using enzyme-linked immunosorbent assay (ELISA).The serum alpha-fetoprotein (AFP),carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels were also measured using radioimmunoassay (RIA).All data were analyzed by Mann-Whitney U test and Receiver Operating Characteristics (ROC)curves.Results CEA,CA19-9,and KL-6 mucin in serum and KL-6 mucin in bile in patients with malignant tumors were significantly higher than those in patients with benign lesions (P ＜ 0.001).There were no significant differences in serum AFP between the two groups.An receiver operating characteristic (ROC)curves analysis revealed that the detection of KL-6 mucin in bile was reasonably accurate in differentiating malignant obstructive jaundice from benign (area under curve [AUC] 0.954).While the AUC of the ROC curves for serum AFP,CEA,CA19-9,KL-6 mucin and KL-6 in bile and 0.954 were 0.657,0.753,0.894,0.846 and 0.954 respectively.Using the ideal threshold as the cut-off point,the sensitivity and specificity of KL-6 mucin for differential diagnosis of benign and malignant obstructive jaundice was 90.24％and 93.33％.Conclusion As a tumor marker,KL-6 mucin in bile is valuable in differential diagnosis of benign and malignant obstructive jaundice.
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Objective Spontaneous pneumothorax occurred mainly because of bulla rupture and its formation process and pathogenesis were unknown,the study was to detect the express level of the cytokines KL-6,FGF-10 and MMP-9 in the spontaneous pneumothorax patients with bulla and researched its significance.Methods Selected 24 cases of bulla resection for spontaneous pneumothorax patients,the immunohistochemical staining techniques and enzyme-linked immunosorbent assay (ELISA) was taken to detect the expression level of KL-6,FGF-10 and MMP-9 of the bulla site and the bulla adjacent site.Results Immunohistochemical results showed that the staining intensity of the KL-6 and FGF-10 in groups of bulla site was higher than those in groups of bulla adjacent site while there was no significant difference of MMP-9 in the two groups.ELISA results showed that the expression levels of the KL-6 and FGF-10 in groups of bulla site are higher than those in groups of bulla adjacent site and the results had statistically significant (P ＜ 0.05),while there was no statistically significant of MMP-9 in the two groups(P ＞0.05).Conclusion The expression of the KL-6 and FGF-10 in the bulla site in primary spontaneous pneumothorax patients was higher than that in the normal site ; the pulmonary fibrosis mediated by KL-6 and the lung-bronchial congenital abnormalities mediated by abnormal expression of FGF-10 might have correlation with bulla formation.There was no statistically significant of the MMP-9 expression between the two groups and the correlation between inflammation mediated by MMP-9 and bulla formation was not clear.
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Krebs von den Lungen-6(KL-6) is a high-molecular-weight transmembrane mucin.In recent research,the levels of KL-6 in serum and bronchoalveolar lavage fluid are significantly higher in some pulmonary disease such as interstitial lung disease,acute lung injury,tumor and bronchopulmonary dysplasia.Consequently KL-6 is recommended as a reference index for early diagnosis,evaluation of therapeutic efficiency and outcome prediction.But the molecular mechanism of KL-6 in different diseases requires further research.
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Objective To explore the expression of KL-6/MUC1 and the possible impact on alveolar development in lung tissue of newborn rats with hyperoxia-induced bronchopulmonary dysplasia (BPD).Methods Sixty-four newborn rats were randomly divided into 2 groups:hyperoxic group and control group.The rats in hyperoxic group were exposed to high oxygen volume fraction of 900 mL/L,and the rats in control group were exposed to normal oxygen volume fraction of 210 mL/L.The experimental control factors were the same in two groups.Eight rats were randomly selected from each group on day 1,3,7,and 14 after oxygen exposure.The alveolar development was evaluated by the number of radial alveolar count (RAC) and the alveolar area/pulmonary septal area ratio (A/S).The location,distribution,and expression of KL-6/MUC1 in the lung tissue were detected by the fluorescent immunoassay,Western blot,and reverse transcription polymerase chain reaction.Results Compared with the control group,the RAC in hyperoxic group decreased on day 3 and continued to decline on day 14.The A/S in hyperoxic group increased on day 7 and peaked on day 14 (P ＜0.05).KL-6/MUC1 expressed in both bronchial epithelial cells and alveolar epithelial cells of newborn rats.KL-6/MUC1 protein in hyperoxic group peaked on day 1 and decreased later,which was higher than that of the control group (P ＜ 0.05),the level of KL-6/MUC1 was positively correlated with RAC (r =0.707,P ＜ 0.05)and negatively correlated with A/S(r =-0.716,P ＜ 0.05).MUC1 mRNA in hyperoxic group was slightly higher than that in control group,but no significant inter-or intra-group difference was observed (P ＞ 0.05).Conclusions The highest expression of KL-6/MUC1 can be observed in the early phase of hyperoxic exposure,and it decreases to the lowest on the key point of pulmonary development.KL-6/MUC1 may play an important role in the alveolar development.
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Serum KL-6 is a category of glycoprotein coded by the epithelium of sticky protein 1(MUC1) gene,which has already been regarded as an indicator of interstitial lung diseases,and later found highly expressed in part of malignant tumor patients.In recent years,studies has found that serum KL-6 is associated with the incidence of radioactive pneumonia,and monitoring serum KL-6 can predict the occurrence of radioactive pneumonia as well assess the severity and prognosis of disease.
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ObjectiveTo discuss the content of serum C-reactive protein and the glycoprotein KL- 6 in hand-foot and mouth disease complicated with neurogenic pulmonary edema children,and discuss related nursing measures,in order to provide the basis for diagnosis of hand-foot and mouth disease complicated with neurogenic pulmonary edema. Methods96 cases of children patients with hand- foot and mouth disease complicated with neurogenic pulmonary edema from January 2010 to June 2011 were selected at random in our hospital,56 cases were heavy patients,40 patients were common type.Another 48 cases were randomly selected healthy volunteers.Using the turbidity to determine the content of C-reactive protein in serum,the Elisa method to determine the content of glycoprotein KL-6.The results were compared and the related nursing measures were summarized. ResultsThe results of the turbidity for C-reactive protein showed that heavy patients were with the highest levels of CRP,common type followed subsequently,while the healthy group was normal.The results of Elisa for glycoprotein KL-6 showed that heavy patients were with the highest levels of glycoprotein KL-6,Common type followed subsequently,the healthy group was normal.By data analysis,we found that the two kinds of test results between three groups were obviously different. ConclusionsThrough comparative analysis,we found that the content of C- reactive protein and the glycoprotein KL-6 were positively correlated with the order of severity of hand-foot and mouth disease complicated with neurogenic pulmonary edema,which can be used as index of clinical judgment of the severity of the disease.Reasonable care measures are very impartant for recovery of the patients.
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Early diagnosis of drug-induced pneumonitis (DP) is important because timely drug withdrawal will significantly reduce the risk of irreversible fibrosis. Although DP is diagnosed based on the patient's history, physical examinations and laboratory data, a definitive diagnosis of DP is difficult because the clinical and laboratory data are often nonspecific. And the diagnostic methods for DP are still an area of debate. Furthermore, DP has characteristics similar to infectious pneumonia and collagen-vascular disease-related pulmonary fibrosis.Thus, infectious pneumonia and collagen-vascular disease-related pulmonary fibrosis are important considerations for the differential diagnosis of DP. The drug-induced lymphocyte stimulation test (DLST) is widely used to diagnose drug-induced pneumonia in Japan. However, the DLST is not reliable for the diagnosis of DP because the false-positive and-negative rates are relatively high and there are other limitations with the DLST.On the other hand, serum KL-6 produced by type II pneumocytes is a useful marker for the diagnosis of DP, because serum KL-6 levels are high in DP but low in bacterial pneumonia, <i>Mycoplasma pneumoniae pneumonia </i>and <i>Chlamydia pneumoniae </i>pneumonia. Other laboratory methods related to DP are also described in this article. Some herbal medicines may also induce DP. However, in several reports of herbal medicine-induced pneumonitis, DP was often diagnosed with DLST and/or infection was not excluded. Once the diagnosis of DP is definite, we should not continue using the causative drug, even if it is useful for the treatment of a specific disease. Clearly, the definitive diagnosis of DP involves careful consideration.
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[Case Report]A female in her fifties complaining of numbness on her face and stickiness in the month who was diagnosed with scleroderma.<BR>Although some other symptoms were improved by the administration of medicine, her main complaints did not change. We applied acupuncture aiming at adjusting the autonomous nerves and it had a little effect for face numbness, Raynaud and KL-6 but numbness on her face did not change since suspending treatment. We changed the method of acupuncture in regards to palpation and it was more effective for her main complaint. <BR>[Method]Watching the change of the patient's subjectivity of a numbness on her face, frequency of sleeplessness and Raynaud, quantity of medicine, and the result of a blood test.<BR>[Result]Both her general condition and numbness on her face were relieved after acupuncture treatment. Especially acupuncture in regard to palpation for general care was more effective. There was no change in stickiness in the mouth.<BR>[Conclusion]We suggest that acupuncture treatment with medicine might be effective for symptoms of scleroderma. These changes will relieve anxiety for their disease and the secondary effect of medicine.
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Objective To detect the expression of KL-6 mucin in the tissue and serum of hepatoma in different hepatoma patients,and to investigate the value of KL-6 mucin as a tumor marker in the diagnosis of hepatoma.Methods The expression of KL-6 mucin in the hepatoma tissues of 81 patients with hepatocellular carcinoma(HCC),21 patients with cholangiocarcinoma(CC),12 patients with combined hepatocellular and cholangiocarcinoma(HCC-CC)and 56 patients with metastatic liver cancer(MLC)was detected by immunohistochemical analysis.The expression of KL-6 mucin in the serums of 34 HCC patients,8 CC patients,30 MLC patients and 19 healthy individuals was detected by enzyme-linked immunosorbent assay,and all the data were analyzed by t test.Results Expression of KL-6 mucin was detected in the cholangiocarcinoma tissues in all CCand HCC-CC patients.In several hepatoma cells and partial hepatoma tissues of patients with MLC,the expression of KL-6 mucin was detected.No expression of KL-6 mucin was detected in the hepatocellular carcinoma tissuesand non-cancerous tissues of patients with HCC or HCC-CC.The serum levels of KL-6 mucin expression in CC patients were signifcantly higher than those in healthy individuals,HCC and MLC patients(t=5.58,5.34,4.00.P＜0.01).The difference of the serum levels of KL-6 mucin expression between MLC patients and healthy individuals had statistical significance(t=2.77,P＜0.01).However,no significant difference in serum levels of KL-6 mucin expression was found between HCC patients and healthy individuals and between HCC patients and MLC patients(t=2.03,1.89,P＞0.05).Conclusion The expression of KL-6 inucin in CC patients is significantly higher than in patients with other types of hepatoma in both tissue and serum levels.Thus,KL-6 may be a usetul new tmnor marker for distinguishing CC from other types of hepatoma.
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Objective To determine the serum level of KL-6 in patients with polymyositis(PM)and dermatomyositis(DM),and to investigate the possible diagnostic value for interstitial lung diseases(ILD)in pa- tients with PM/DM.Methods Serum KL-6 concentrations were measured by ELISA in 53 adult PM/DM pa- tients,the control groups of 22 patients with infectious lung disease,and 50 healthy subjects.The association with clinical features and serum KL-6 levels was analyzed.Results The serum levels of KL-6 were(1543?761)、(429?106)、(336?196)and(289?105)U/ml in PM/DM patients with ILD and without ILD,patients with infectious lung disease and healthy controls,respectively.Serum KL-6 levels in the PM/DM patients with ILD were significantly higher compared with PM/DM patients without ILD,patients with infectious lung disease and healthy controls(all P＜0.01 ).However,no significant differences of serum KL-6 levels was found among PM/ DM patients without ILD,patients with infectious lung disease and healthy controls(P＞0.05).Significant cor- relations were found between the elevated levels of serum KL-6 and the presence of ILD in patients with PM/ DM(P＜0.01).The sensitivity and specificity of serum abnormal KL-6 levels for ILD in patients with PM/DM were 90.9% and 80.6%.Additionally,follow-up study showed the mean serum levels of KL-6 in six patients who died were significantly higher than that in other PM/DM patients with ILD(P＜0.01).Conclusion Serum KL-6 level is a reliable serum marker for ILD in idiopathic inflammatory myopathies,which may contribute to early differentiate ILD from lung infectious disease.Increased serum level of KL-6 may predict a poor out- come.