进展期寻常型银屑病患者血清YKL-40水平变化及临床意义

Changes in levels of serum YKL-39 in patients with psoriasis vulgaris and its clinical significance

目的探讨进展期寻常型银屑病患者血清人软骨糖蛋白39(YKL-40)的水平变化及临床意义。方法选择寻常型银屑病患者109例作为病例组,根据银屑病面积与严重性指数(PASI)评分将其分为轻度组(PASI评分≤15分)52例,中度组(15分<PASI评分<30分)37例,重度组(PASI评分≥30分)20例;同期随机选取60例体检健康者为对照组。采用酶联免疫吸附法检测血清TKL-40及炎性细胞因子白细胞介素17(IL-17)、IL-21、IL-22、IL-23水平。用Pearson积矩相关法分析血清YKL-40水平与PASI评分、炎性细胞因子的相关性。绘制受试者工作特征(ROC)曲线,并计算ROC曲线下面积(AUC)评价血清YKL-40对寻常型银屑病的诊断价值。结果病例组血清YKL-40、IL-17、IL-21、IL-22、IL-23水平均高于对照组(P均<0.05)。轻度组、中度组、重度组血清YKL-40、IL-17、IL-21、IL-22、IL-23水平比较差异有统计学意义(P均<0.05);且患者病情越重,血清YKL-40、IL-17、IL-21、IL-22、IL-23水平越高(P均<0.05)。银屑病患者血清YKL-40水平与PASI评分、IL-17、IL-21、IL-22、IL-23均呈正相关(r分别为0.792、0.751、0.783、0.811、0.765,P均<0.05)。YKL-40诊断寻常型银屑病的AUC为0.938(95%CI:0.893~0.983),约登指数0.73,最佳截断值为56.82μg/mL,此时的灵敏度、特异度分别为0.89、0.92,准确性为0.93。结论进展期银屑病患者血清YKL-40水平升高;血清YKL-40可反映患者病情严重程度,且参与炎症反应,有望成为辅助诊断进展期寻常型银屑病的指标之一。

Objective To explore the expression levels of serum human cartilage glycoprotein 39(YKL-40)in patients with psoriasis vulgaris and its clinical significance.Methods A total of 109 patients with psoriasis vulgaris(the case group)were divided into the mild group(n=52),moderate group(n=37),and severe group(n=20)according to the psoriasis area and severity index(PASI).At the same time,60 healthy volunteers were randomly selected as the control group.Serum YKL-40 and inflammatory cytokines such as IL-17,IL-21,IL-22,IL-23 levels were detected by enzyme-linked immunosorbent assay.Pearson product moment correlation analysis was used to analyze the associations of serum YKL-40 with PASI,IL-17,IL-21,IL-22,and IL-23.We drew the receiver operating characteristic(ROC)curve and calculated the area under the ROC curve(AUC)to evaluate the diagnostic value of serum YKL-40 for psoriasis vulgaris.Results The serum levels of YKL-40,IL-17,IL-21,IL-22 and IL-23 in the case group were higher than those in control group(all P<0.05).With the severity of psoriasis vulgaris,the levels of serum YKL-40,IL-17,IL-21,IL-22,IL-23 increased gradually(all P<0.05).The serum YKL-40 was positively correlated with PASI score(r=0.792,P<0.05),and was positively correlated with inflammatory cytokines such as IL-17,IL-21,IL-22,IL-23(r=0.751,0.783,0.811,0.765;all P<0.05).The AUC of YKL-40 in the diagnosis of psoriasis vulgaris was 0.938(95%CI:0.893-0.983),the cut-off value was 56.82μg/ml,the sensitivity and specificity were 0.89 and 0.92,respectively,and the accuracy was 0.93.Conclusions YKL-40 increases in the pathogenesis of psoriasis vulgaris,which can reflect the severity of the disease and participate in the inflammatory response.Early detection can be used as marker for clinical diagnosis of psoriasis vulgaris.