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目的 测定B细胞活化因子(BAFF)对自身免疫性疾病(AIDs)引起的寻常型间质性肺炎(UIP)与特发性肺纤维化(IPF)的鉴别诊断价值.方法 回顾性分析2015年1月至2016年3月于北京协和医院就诊的IPF患者34例(IPF组)、AIDs-UIP患者23例(AIDs-UIP组)及同期体检的健康对照者21名(对照组),其中IPF组男31例,女3例,年龄40 ～77岁,平均(63 ±8)岁;AIDs-UIP组男16例,女7例,年龄25 ～73岁,平均(60 ±9)岁,其中类风湿关节炎12例,系统性血管炎7例,干燥综合征2例,系统性硬化1例,自身免疫相关的间质性肺炎1例;对照组男17名,女4名,年龄51 ～80岁,平均(64 ±8)岁.采用酶联免疫吸附试验(ELISA)方法检测3组血浆中BAFF的水平,分析BAFF与肺功能等临床指标的相关性,使用受试者工作特征曲线(ROC)评价BAFF在鉴别AIDs-UIP与IPF中的价值.结果 AIDs-UIP组血浆中BAFF浓度为(2.3 ±0.9) ng/ml,明显高于IPF组[(1.6 ±0.4) ng/ml,t＝3.05,P＝0.005]及对照组[(1.2 ±0.2) ng/ml, t＝5.12,P＜0.001],AIDs-UIP组血浆BAFF水平与肺功能指标中的FVC占预计值%[(72 ±20)%]、肺总量占预计值%[(67 ±16)%]和DLCO占预计值%[(52 ±16)%]呈负相关(r＝-0.435、-0.449、-0.491,均P＜0.05).当临界值取1.5 ng/ml时,血浆BAFF从所有UIP患者中诊断AIDs-UIP的敏感度为64.5%,特异度为90.0%,受试者工作特征曲线下面积最大为0.784(P＜0.01,95%CI:66.3%～90.5%).结论 AIDs-UIP患者血浆BAFF水平高于IPF组及对照组.血浆BAFF含量与AIDs-UIP患者的肺功能受损程度呈负相关. BAFF的表达可能与AIDs-UIP的发生、发展有关,可作为鉴别AIDs-UIP与IPF的生物标志物.

Objective To explore the differential diagnostic role of B cell-activating factor(BAFF) in idiopathic pulmonary fibrosis (IPF) and usual interstitial pneumonia (UIP) associated with autoimmune diseases (AIDs).Methods Plasma levels of BAFF were measured by ELISA method in 23 patients with AIDs-UIP, 34 patients with IPF, and 21 healthy subjects as control.The correlation between plasma BAFF levels and other clinical results from patients was analyzed.Receiver operating characteristics ( ROC) analysis for distinguishing AIDs-UIP from IPF patients was examined and the maximal area under curve (AUC) was found.Results Plasma levels of BAFF were significantly elevated in AIDs-UIP patients and IPF patients compared to healthy subjects (P＜0.001 and P＝0.002, respectively).AIDs-UIP patients had higher level of BAFF than IPF patients ( P ＝0.030).Plasma BAFF levels in AIDs-UIP patients were inversely correlated with pulmonary function results ,including FVC%(r＝-0.435, P＝0.040)and TLC%(r＝-0.449, P＝0.041), as well as DLCO%(r＝-0.491, P＝0.024).When the cut off value of BAFF was set as 1.5 ng/ml to distinguish AIDs-UIP patients from IPF patients , the sensitivity and the specificity was 64.5%and 90.0%, respectively, and the area under ROC curve reached the maximum of 0.784(P＝0.000, 95% CI: 66.3% -90.5%).Conclusions Plasma BAFF levels were significantly higher and inversely correlated with pulmonary function , reflecting the severity of AIDs-UIP patients.Plasma BAFF levels may be a useful marker for distinguishing AIDs-UIP from IPF.