State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Respirology. 2014 May;19(4):608-15. doi: 10.1111/resp.12283. Epub 2014 Apr 1.
Pulmonary vascular remodelling and inflammation have been implicated in pulmonary arterial hypertension (PAH). YKL-40, a marker of tissue remodelling and inflammation, has recently been recognized as a risk predictor of cardiovascular and inflammatory diseases. The study aimed to investigate a potential role of YKL-40 in predicting prognosis in idiopathic PAH (IPAH).
Plasma YKL-40 levels were measured in 82 IPAH patients without current or previous PAH-specific treatment during right heart catheterization and in 54 healthy volunteers. Concurrent data included clinical, haemodynamic and biochemical variables.
Plasma YKL-40 levels were increased in IPAH patients compared with control subjects (median, interquartile range: IPAH: 24.90, 17.68-39.78 ng/mL; controls: 16.58, 14.20-19.64 ng/mL; P < 0.001). YKL-40 levels correlated with cardiac index (r = -0.244, P = 0.027) and N-terminal pro-brain natriuretic peptide (NT-proBNP, r = 0.263, P = 0.017). After a median follow-up of 578 days, YKL-40 outperformed NT-proBNP, uric acid, and 6-min walk distance in receiver operating characteristic (ROC) analyses in predicting both clinical worsening (area under the curve (AUC) 0.681) and death (AUC 0.717). Compared with patients with YKL-40 below the ROC-derived cut-off point (24.5 ng/mL), the high YKL-40 group showed higher pulmonary vascular resistance and serum uric acid levels, and showed more clinical worsening events and deaths in Kaplan-Meier analyses. Plasma YKL-40 was independently associated with clinical worsening in univariate and multivariate Cox analyses (all P < 0.05).
Plasma YKL-40 might serve as a promising indicator of disease severity and prognosis in patients with IPAH.
肺血管重构和炎症与肺动脉高压（PAH）有关。YKL-40 是组织重构和炎症的标志物，最近被认为是心血管和炎症性疾病的风险预测因子。本研究旨在探讨 YKL-40 在预测特发性 PAH（IPAH）预后中的潜在作用。
在右心导管检查期间，测量了 82 例未经当前或既往 PAH 特异性治疗的 IPAH 患者和 54 名健康志愿者的血浆 YKL-40 水平。同时记录了临床、血流动力学和生化变量。
与对照组相比，IPAH 患者的血浆 YKL-40 水平升高（中位数，四分位距：IPAH：24.90，17.68-39.78ng/ml；对照组：16.58，14.20-19.64ng/ml；P<0.001）。YKL-40 水平与心指数（r=-0.244，P=0.027）和 N 端脑利钠肽前体（NT-proBNP，r=0.263，P=0.017）呈负相关。中位随访 578 天后，YKL-40 在预测临床恶化（ROC 分析的曲线下面积（AUC）0.681）和死亡（AUC 0.717）方面均优于 NT-proBNP、尿酸和 6 分钟步行距离。与 YKL-40 低于 ROC 衍生的截断点（24.5ng/ml）的患者相比，高 YKL-40 组的肺血管阻力和血清尿酸水平更高，Kaplan-Meier 分析显示更多的临床恶化事件和死亡。在单变量和多变量 Cox 分析中，血浆 YKL-40 与临床恶化均相关（均 P<0.05）。
血浆 YKL-40 可能是 IPAH 患者疾病严重程度和预后的一个有前途的指标。
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