Stereotactic body radiation therapy(SBRT)has a locacontrol rate of 95%at 2 years for non-small cell lungcancer(NSCLC)and should improve the prognosis oinoperable patients,elderly patients,and patients withsignificant ...Stereotactic body radiation therapy(SBRT)has a locacontrol rate of 95%at 2 years for non-small cell lungcancer(NSCLC)and should improve the prognosis oinoperable patients,elderly patients,and patients withsignificant comorbidities who have early-stage NSCLCThe safety of SBRT is being confirmed in internationalmulti-institutional PhaseⅡtrials for peripheral lungcancer in both inoperable and operable patients,bureports so far have found that SBRT is a safe and effective treatment for early-stage NSCLC and early metastatic lung cancer.Radiation pneumonitis(RP)is oneof the most common toxicities of SBRT.Although mospost-treatment RP is Grade 1 or 2 and either asymptomatic or manageable,a few cases are severe,symptomatic,and there is a risk for mortality.The reportedrates of symptomatic RP after SBRT range from 9%to28%.Being able to predict the risk of RP after SBRT isextremely useful in treatment planning.A dose-effecrelationship has been demonstrated,but suggesteddose-volume factors like mean lung dose,lung V20and/or lung V2.5 differed among the reports.We foundthat patients who present with an interstitial pneumo-nitis shadow on computed tomography scan and high levels of serum Krebs von den Lungen-6 and surfactant protein D have a high rate of severe radiation pneumo-nitis after SBRT.At our institution,lung cancer patients with these risk factors have not received SBRT since 2006,and our rate of severe RP after SBRT has de-creased significantly since then.展开更多
目的 研究血清KL-6（Krebs von den lungen-6）作为生物标志物对CTD肺间质病变诊断、影像表现及活动性评估的价值。方法75例CTD患者分为合并肺间质病变组（44例）、不合并肺间质病变组（31例），而合并肺间质病变组再按肺CT影像分型及...目的 研究血清KL-6（Krebs von den lungen-6）作为生物标志物对CTD肺间质病变诊断、影像表现及活动性评估的价值。方法75例CTD患者分为合并肺间质病变组（44例）、不合并肺间质病变组（31例），而合并肺间质病变组再按肺CT影像分型及分级再分别分为3组，按肺间质病变活动与非活动分为2组。以ELISA法测定血清KL-6浓度，数据不服从正态分布，用独立样本非参数检验比较各组间的差异。结果CTD肺间质病变组的血清KL-6浓度[（1 118±877）U/ml]明显高于不合并肺间质病变组[（253±144）U/ml]，差异具有统计学意义（Z=-6.047，P〈0.01）。以500 U/ml为阳性标准，血清KL-6浓度对CTD合并肺间质病变诊断的敏感性、特异性、阳性预测值、阴性预测值分别为72.7%、87.1%、88.9%、69.2%。在合并肺间质病变组的影像分型中，寻常型间质性肺炎（UIP型，蜂窝病变为主）、非特异性间质性肺炎（NSIP型，毛玻璃与网格病变为主）与未定型分组间的血清KL-6浓度[分别为（1 104±843）U/ml、（1 242±1 039）U/ml、（815±400）U/ml]差异无统计学意义（χ2=0.35，P=0.84）。但合并肺间质病变组的影像病变累积分级中，病变分布范围广的患者血清KL-6浓度[（1 910±918）U/ml]较病变分布范围窄组的血清KL-6浓度[（459±268）U/ml]更高（Z=-4.364，P〈0.01）。肺间质病变活动组患者的血清KL-6浓度[（1 478±917）U/ml]也较肺间质病变非活动组[（598±475）U/ml]的高（Z=-3.915，P〈0.01）。结论血清KL-6浓度测定有利于CTD肺间质病变的诊断及肺病变范围及活动度的评估。展开更多
目的观察老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)患者血清白细胞介素-6(interleukin-6, IL-6)、涎液化糖链抗原-6(Krebs von den Lungen-6, KL-6)及载脂蛋白a(apolipopr...目的观察老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)患者血清白细胞介素-6(interleukin-6, IL-6)、涎液化糖链抗原-6(Krebs von den Lungen-6, KL-6)及载脂蛋白a(apolipoprotein a, APOA)表达情况,探讨其预测AECOPD患者近期预后的价值。方法 93例老年AECOPD患者均接受规范化治疗,分别于入院时及出院前1 d检测血清IL-6、KL-6及APOA水平,出院后随访1年,根据随访期间是否再次出现急性加重分为预后良好组58例和预后不良组35例;比较2组入院时临床资料及血清IL-6、KL-6、APOA水平。采用多因素logistic回归分析老年AECOPD患者出院后发生近期预后不良的影响因素,采用Spearman相关性分析老年AECOPD患者血清IL-6、KL-6、APOA水平之间的相关性;绘制ROC曲线,评估入院时血清IL-6、KL-6、APOA水平对老年AECOPD患者发生近期预后不良的预测效能。结果 93例老年AECOPD患者中,35例再次出现急性加重,发生率为37.63%;93例患者出院前1 d血清IL-6[11.94(11.04,13.56)pg/L]、KL-6[40.09(38.52,41.77)u/mL]水平均低于入院时[15.64(13.25,16.90)pg/L、47.57(43.17,51.34)u/mL](P<0.05),APOA水平[1.90(1.74,2.05)g/L]高于入院时[1.54(1.21,1.85)g/L](P<0.05);预后不良组入院时血清IL-6[17.17(15.79,19.15)pg/L]、KL-6[53.39(48.81,54.55)u/mL]水平均高于预后良好组[14.10(12.24,15.96)pg/L、44.54(40.98,48.54)u/mL](P<0.05),APOA水平[1.21(1.01,1.40)g/L]低于预后良好组[1.76(1.51,1.98)g/L](P<0.05);血清IL-6(OR=2.601,95%CI:1.257~5.382,P=0.010)、KL-6(OR=1.692,95%CI:1.319~2.171,P<0.001)、APOA水平(OR=0.007,95%CI:<0.001~0.094,P<0.001)是老年AECOPD患者出院后发生近期预后不良的影响因素;当入院时血清IL-6、KL-6、APOA水平最佳截断值分别为15.333 pg/L、46.759 u/mL、1.640 g/L时,单独及联合检测预测AECOPD患者出院后发生近期预后不良的AUC分别为0.861(95%CI:0.789~0.932,P<0.001)、0.893(95%CI:0.828~0.957,P<0.001)、0.850(95%CI:0.772~0.927展开更多
间质性肺疾病(interstitial lung disease,ILD)是以弥漫性肺实质、肺泡炎症和间质纤维化为基本病理表现的慢性进展型疾病,缺乏特异性诊断方法。血清学标志物,特别是涎液化糖链抗原-6(Krebs von den Lungen-6,KL-6),正日益受到人们关注。...间质性肺疾病(interstitial lung disease,ILD)是以弥漫性肺实质、肺泡炎症和间质纤维化为基本病理表现的慢性进展型疾病,缺乏特异性诊断方法。血清学标志物,特别是涎液化糖链抗原-6(Krebs von den Lungen-6,KL-6),正日益受到人们关注。KL-6是一种跨膜高分子量黏蛋白,主要表达于Ⅱ型肺泡细胞和支气管上皮细胞的细胞质和胞膜。近年来,大量研究发现KL-6表达可能与肿瘤、部分新生儿肺部疾病、ILD及其恶化、急性肺损伤等疾病相关,其在ILD中的作用受到特别关注,但具体机制仍不清楚。本文对KL-6的结构特点,其在ILD患者血清及肺泡灌洗液中的异常表现与ILD病变发生、进展、药物疗效及预后的相关性作一综述,以期为临床研究提供最新信息。展开更多
文摘Stereotactic body radiation therapy(SBRT)has a locacontrol rate of 95%at 2 years for non-small cell lungcancer(NSCLC)and should improve the prognosis oinoperable patients,elderly patients,and patients withsignificant comorbidities who have early-stage NSCLCThe safety of SBRT is being confirmed in internationalmulti-institutional PhaseⅡtrials for peripheral lungcancer in both inoperable and operable patients,bureports so far have found that SBRT is a safe and effective treatment for early-stage NSCLC and early metastatic lung cancer.Radiation pneumonitis(RP)is oneof the most common toxicities of SBRT.Although mospost-treatment RP is Grade 1 or 2 and either asymptomatic or manageable,a few cases are severe,symptomatic,and there is a risk for mortality.The reportedrates of symptomatic RP after SBRT range from 9%to28%.Being able to predict the risk of RP after SBRT isextremely useful in treatment planning.A dose-effecrelationship has been demonstrated,but suggesteddose-volume factors like mean lung dose,lung V20and/or lung V2.5 differed among the reports.We foundthat patients who present with an interstitial pneumo-nitis shadow on computed tomography scan and high levels of serum Krebs von den Lungen-6 and surfactant protein D have a high rate of severe radiation pneumo-nitis after SBRT.At our institution,lung cancer patients with these risk factors have not received SBRT since 2006,and our rate of severe RP after SBRT has de-creased significantly since then.
文摘间质性肺疾病(interstitial lung disease,ILD)是以弥漫性肺实质、肺泡炎症和间质纤维化为基本病理表现的慢性进展型疾病,缺乏特异性诊断方法。血清学标志物,特别是涎液化糖链抗原-6(Krebs von den Lungen-6,KL-6),正日益受到人们关注。KL-6是一种跨膜高分子量黏蛋白,主要表达于Ⅱ型肺泡细胞和支气管上皮细胞的细胞质和胞膜。近年来,大量研究发现KL-6表达可能与肿瘤、部分新生儿肺部疾病、ILD及其恶化、急性肺损伤等疾病相关,其在ILD中的作用受到特别关注,但具体机制仍不清楚。本文对KL-6的结构特点,其在ILD患者血清及肺泡灌洗液中的异常表现与ILD病变发生、进展、药物疗效及预后的相关性作一综述,以期为临床研究提供最新信息。
