YKL-40对特发性肺动脉高压患者预后的意义

Value of YKL-40 in the Prognosis of Patients with Idiopathic Pulmonary Arterial Hypertension

【目的】探讨YKL-40对特发性肺动脉高压患者预后的预测作用。【方法】收集2016年1月至2018年3月在广东省人民医院住院的82例特发性肺动脉高压(IPAH)患者病历资料进行回顾性分析,根据临床结局分为死亡组和存活组。采用酶联免疫吸附测定法检测血清YKL-40,使用Vivid 7超声平台采集超声心动图相关数据。【结果】IPAH死亡组患者的血清YKL-40水平明显高于存活[95.3(13.1~217.3)ng/mL vs. 11.0(5.7~47.7)ng/mL,P=0.006],三尖瓣环收缩期峰值速度(TAPSV)低于存活组[7(6.0~8.0)cm/s vs. 9(7.0~11.0)cm/s,P=0.001]。IPAH患者血清YKL-40水平与N端脑钠肽前体、肺动脉平均压、肺血管阻力呈正相关。Logistic回归分析显示TAPSE/lgYKL-40、TAPSV/lgYKL-40与IPAH患者的死亡结局相关,OR值分别为0.722和0.519,OR值的95%置信区间分别为(0.368,0.987)和(0.283,0.951)(P<0.05)。【结论】YKL-40联合超声心动图参数对特发性肺动脉高压患者的临床结局有预测意义。

【Objective】To explore the predictive value of YKL-40 in the prognosis of patients with idiopathic pulmonary hypertension.【Methods】The medical records of 82 patients with idiopathic pulmonary arterial hypertension(IAPH)who were hospitalized in Guangdong Provincial People’s Hospital from January 2016 to March 2018 were collected for retrospective analysis. According to the clinical outcome,they were divided into death group and survival group. The enzymelinked immunosorbent assay was used to detect serum YKL-40,and the Vivid 7 ultrasound platform was used to collect echocardiographic data.【Results】The level of serum YKL-40 in the IPAH death group was significantly higher than that of the survival group[95.25(13.10~217.25)ng/mL vs. 10.96(5.73~47.65)ng/mL,P=0.006];the tricuspid annulus systolic displacement(TAPSE)of the death group was smaller than that of the survival group(15.00(13.50~16.25)mm vs.14.35(11.00~16.00)mm,P=0.398);and the tricuspid annulus peak systolic velocity(TAPSV)of the death group was lower than that of the survival group[7.00(6.00~8.00)cm/s vs. 9.00(7.00~11.00)cm/s,P= 0.001]. Serum YKL-40 levels in patients with IPAH were positively correlated with N-terminal pro-brain natriuretic peptide,pulmonary arterial mean pressure and pulmonary vascular resistance. Logistic regression analysis showed that TAPSE/lgYKL-40 and TAPSV/lgYKL-40 had statistical significance in predicting the death outcome of IAPH patients(P<0.05),odds ratio were 0.722 and 0.519,respectively;and their corresponding 95% CIs were(0.368,0.987)and(0.283,0.951),respectively.【Conclusion】YKL-40 combined with echocardiographic parameters has predictive significance for the clinical outcome of patients with IPAH.