Clinical Utility of YKL-40 in Polymyositis/dermatomyositis-associated Interstitial Lung Disease
Clinical Utility of YKL-40 in Polymyositis/dermatomyositis-associated Interstitial Lung Disease
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DOI：
10.3899/jrheum.170373
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发表时间：
2017-09-01
影响因子：
3.9
通讯作者：
Suda, Takafumi
中科院分区：
文献类型：
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作者：
Hozumi, Hironao;Fujisawa, Tomoyuki;Suda, Takafumi
客观的。间质性肺病（ILD）与多发性肌炎/皮肌炎（PM/DM）有关，这是一种预后不良的疾病。 Chitinase-3-like-1 蛋白 (YKL-40) 具有多效性生物活性，涉及炎症、细胞增殖和组织重塑；然而，YKL-40的临床应用仍然有限。我们研究了 YKL-40 在 PM/DM-ILD 中的临床意义。方法。对 69 名连续患有 PM/DM-ILD 的患者和 34 名健康对照进行了分析。我们使用 ELISA 测量基线和随访血清 YKL-40，评估 YKL-40 与临床变量和生存的关联，并使用免疫组织化学检查 PM/DM-ILD 患者肺标本中的 YKL-40 表达。结果。与健康对照相比，PM/DM-ILD 患者的血清 YKL-40 水平显着升高 (p < 0.0001)。 PM/DMILD 患者的血清 YKL-40 与动脉氧分压（r = -0.40，p < 0.001）和预测 DLCO 百分比（r = -0.41，p = 0.01）相关。多变量 Cox 风险分析表明，较高的血清 YKL-40 和较低的预测用力肺活量百分比与不良预后独立相关。免疫组织化学分析表明，PM/DM-ILD 患者聚集的肺泡内巨噬细胞和过度增殖的肺泡上皮细胞中 YKL-40 表达增强。结论。 YKL-40 是一种有前途的生物标志物，可用于评估 PM/DM-ILD 活性/严重程度和预测疾病预后。对 YKL-40 的深入了解可能有助于阐明 PM/DM-ILD 的发病机制。
Objective. Interstitial lung disease (ILD) is involved in polymyositis/dermatomyositis (PM/DM), a disease associated with poor prognoses. Chitinase-3-like-1 protein (YKL-40) has pleiotropic biological activities involved in inflammation, cell proliferation, and tissue remodeling; however, the clinical application of YKL-40 remains limited. We investigated the clinical significance of YKL-40 in PM/DM-ILD.Methods. Sixty-nine consecutive patients with PM/DM-ILD and 34 healthy controls were analyzed. We measured baseline and followup serum YKL-40 using an ELISA, evaluated the association of YKL-40 with clinical variables and survival, and examined YKL-40 expression in lung specimens from patients with PM/DM-ILD using immunohistochemistry.Results. Serum YKL-40 levels were significantly greater in patients with PM/DM-ILD compared with healthy controls (p < 0.0001). Serum YKL-40 was correlated with arterial oxygen pressure (r = -0.40, p < 0.001) and percent-predicted DLCO (r = -0.41, p = 0.01) in patients with PM/DMILD. Multivariate Cox hazard analysis demonstrated that higher serum YKL-40 and lower percent-predicted forced vital capacity were independently associated with a poor prognosis. Immunohistochemistry analysis demonstrated that YKL-40 expression was enhanced in aggregated intraalveolar macrophages and hyperproliferative alveolar epithelial cells in patients with PM/DM-ILD.Conclusion. YKL-40 is a promising biomarker for evaluating PM/DM-ILD activity/severity and predicting disease prognosis. Insights into YKL-40 might help elucidate the pathogenesis of PM/DM-ILD.