Yang Luyu, Dong Hui, Lu Huizhi, Liao Youxia, Zhang Hao, Xu Lingwen, Tan Yun, Cao Song, Tan Jinhui, Fu Shouzhi
Department of Intensive Care Unit.
Department of Emergency.
Medicine (Baltimore). 2019 Mar;98(12):e14920. doi: 10.1097/MD.0000000000014920.
Serum YKL-40, a potential inflammatory marker, is greatly increased at the early stage of ST-segment elevation myocardial infarction (STEMI). Here, we hypothesized that YKL-40 levels at admission could predict the long-term outcomes after STEMI.A total of 324 patients with acute STEMI undergoing primary percutaneous coronary intervention (PCI) were consecutively enrolled and followed for 24 months. The baseline clinical and procedural data were recorded, and serum YKL-40 levels at admission were measured using ELISA method. The endpoint of interest was major adverse cardiac event (MACE), including all-cause death, recurrent myocardial infarction, and hospitalization for heart failure.Patients with elevated serum YKL-40 levels (≥126.8 ng/mL) were more likely to be older and smoker and to present with type 2 diabetes, advanced Killip class, multivessel disease and intra-aortic balloon pump, with increased levels of admission glucose, triglyceride, and high-sensitivity C-reactive protein and decreased level of high-density lipoprotein cholesterol. During the follow-up period, the incidence of MACE was notably higher in the high than in the low YKL-40 groups (28.4% vs 11.1%, P < .001). Kaplan-Meier curve showed that elevated YKL-40 levels were associated with reduced MACE-free survivals (log-rank P < .001). In multivariate Cox regression analysis, we found that high serum YKL-40 level was an independent predictor of MACE after controlling for clinical and angiographic variables (hazard ratio: 1.65, 95% confidence interval: 1.14-2.39, P = .008).The results of our study indicate that serum YKL-40 may be used as a biomarker to predict the long-term outcome after PCI in patients with STEMI.
血清YKL-40是一种潜在的炎症标志物，在ST段抬高型心肌梗死（STEMI）早期显著升高。在此，我们假设入院时的YKL-40水平可预测STEMI后的长期预后。共连续纳入324例行直接经皮冠状动脉介入治疗（PCI）的急性STEMI患者，并随访24个月。记录基线临床和手术数据，采用酶联免疫吸附测定（ELISA）法测定入院时血清YKL-40水平。感兴趣的终点是主要不良心脏事件（MACE），包括全因死亡、再发心肌梗死和因心力衰竭住院。血清YKL-40水平升高（≥126.8 ng/mL）的患者更可能年龄较大、为吸烟者，且患有2型糖尿病、Killip分级较高、多支血管病变和主动脉内球囊反搏，入院时血糖、甘油三酯和高敏C反应蛋白水平升高，高密度脂蛋白胆固醇水平降低。在随访期间，高YKL-40组的MACE发生率显著高于低YKL-40组（28.4%对11.1%，P<0.001）。Kaplan-Meier曲线显示，YKL-40水平升高与无MACE生存期缩短相关（对数秩检验P<0.001）。在多变量Cox回归分析中，我们发现，在控制临床和血管造影变量后，高血清YKL-40水平是MACE的独立预测因素（风险比：1.65，95%置信区间：1.14-2.39，P=0.008）。我们的研究结果表明，血清YKL-40可作为预测STEMI患者PCI后长期预后的生物标志物。
