並列タイトル等びまん性肺胞出血症候群における予後因子としてKL-6の有用性についての検討
学位博士(医学)
Philosophy in Medical Science
一般注記Background: Diffuse alveolar hemorrhage syndrome is a life threatening condition with diverse etiologies. Sensitive prognostic markers for diffuse alveolar hemorrhage have not been well investigated. Serum KL-6 is a biomarker for various interstitial lung disease associated with disease activity and prognosis. The purpose of the present study was to evaluate the clinical utility of serum KL-6 level as a prognostic marker for diffuse alveolar hemorrhage. Methods: We retrospectively collected 41 consecutive patients clinically diagnosed as having diffuse alveolar hemorrhage who were admitted to the Intensive Care Unit of Hiroshima University Hospital between 2004 and 2011. Correlation between prognosis and age, sex, laboratory findings including serum KL-6, radiological findings, ventilatory modes or therapeutic regimens were evaluated. Results: Baseline and peak serum KL-6 levels were significantly higher in non-survivors compared with survivors. An increase in KL-6 levels during the initial week was associated with a subsequent deterioration of the oxygenation index. Higher baseline KL-6 levels and higher peak KL-6 levels were strongly correlated with death. With a cut-off level of 700 U/mL for peak KL-6, the sensitivity, specificity and accuracy for non-survival were 75%, 85% and 78%, respectively. In the multivariate analysis, only the peak KL-6 level ?700 U/ml was an independent poor prognostic factor for diffuse alveolar hemorrhage. Conclusions: Peak serum KL-6 level ?700 U/ml may become a clinically useful marker of poor prognosis for diffuse alveolar hemorrhage.
Yoshiko Kida, Shinichiro Ohshimo, Kohei Ota, Tomoko Tamura, Tadatsugu Otani, Kazunobu Une, Takuma Sadamori, Yasumasa Iwasaki, Francesco Bonella, Noboru Hattori, Nobuyuki Hirohashi, Josune Guzman, Ulrich Costabel, Nobuoki Kohno and Koichi Tanigawa; KL-6, a Human MUC1 Mucin, as a prognostic marker for diffuse alveolar hemorrhage syndrome; Orphanet Journal of Rare Diseases 2012, 7:99 (doi: 10.1186/1750-1172-7-99)
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