中华皮肤科杂志 ›› 2022, Vol. 55 ›› Issue (6): 523-527.doi: 10.35541/cjd.20210155

• 研究报道 • 上一篇    下一篇

血清几丁质酶3样蛋白1水平在寻常型天疱疮中的临床意义研究

黄雅馨    何渊民    黄书莉    熊霞    邓永琼   

  1. 西南医科大学附属医院皮肤科，泸州  646000
  • 收稿日期:2021-02-24 修回日期:2021-09-17 发布日期:2022-06-02
  • 通讯作者: 邓永琼 E-mail:dengyongqiong1@126.com

An investigation into clinical significance of serum chitinase 3-like protein 1 in pemphigus vulgaris

Huang Yaxin, He Yuanmin, Huang Shuli, Xiong Xia, Deng Yongqiong   

  1. Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
  • Received:2021-02-24 Revised:2021-09-17 Published:2022-06-02
  • Contact: Deng Yongqiong E-mail:dengyongqiong1@126.com

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摘要： 【摘要】 目的 检测寻常型天疱疮患者血清中几丁质酶3样蛋白1（YKL-40）水平，并分析其与病情严重程度的相关性。方法 2017年1月至2018年5月于西南医科大学附属医院皮肤科采集38例寻常型天疱疮患者血清，同时收集14例年龄、性别、体重指数匹配的健康对照者血清，采用多功能流式点阵仪测定血清中YKL-40以及Th1/Th2/Th17相关细胞因子浓度。采用Mann-Whitney U检验分析患者组与对照组细胞因子差异；利用二元Logistic回归法分析与病情严重程度独立相关的因素；绘制受试者操作特征曲线（ROC），采用曲线下面积（AUC）、敏感性及特异性评价YKL-40预测天疱疮严重程度的能力。结果 与对照组相比，寻常型天疱疮患者血清中YKL-40水平［M（Q1，Q3）］［15.22（14.19，15.93）比13.64（13.21，14.63） μg/L，z = -3.88］以及细胞因子白细胞介素（IL）-6［2.05（1.49，4.21）比1.57（1.38，1.75） ng/L，z = -2.44］、IL-7［7.45（5.63，11.63）比3.77（2.21，5.97） ng/L，z = -3.26］、IL-8［6.59（3.60，14.73）比4.36（2.96，6.53） ng/L，z = -1.96］、IL-2R-α［509.08（386.36，757.67）比336.44（309.86，458.71） ng/L，z = -2.35］和C5a水平［100.35（78.31，140.84）比72.08（37.23，82.08） ng/L，z = -3.04］均显著升高（P < 0.05）。天疱疮患者YKL-40血清浓度随着皮损面积的减少而逐渐降低（r = 0.63，P < 0.001），且YKL-40与病情严重程度独立相关［P = 0.025，优势比：46.54（95% CI：1.61 ~ 1 347.19）］。YKL-40区分重度和极重度患者与轻中度患者的AUC为0.783（95% CI：0.613 ~ 0.953）］。结论 血清YKL-40水平与寻常型天疱疮严重程度相关性强，具有预测寻常型天疱疮病情严重程度的潜在价值。

关键词: 天疱疮, 壳多糖酶, 疾病严重程度指数, 生物学标记, Th2细胞, 细胞因子类, 几丁质酶-3样蛋白1

Abstract: 【Abstract】 Objective To detect the serum level of chitinase-3-like protein 1 （YKL-40） in patients with pemphigus vulgaris, and to analyze its correlation with the severity of pemphigus vulgaris. Methods From January 2017 to May 2018, serum samples were collected from 38 patients with pemphigus vulgaris in Department of Dermatology, the Affiliated Hospital of Southwest Medical University, and those collected from 14 age-, gender- and body mass index-matched healthy volunteers served as controls. Serum levels of YKL-40 and Th1/Th2/Th17-related cytokines were detected by using Luminex? 200TM system. Mann-Whitney U test was used to compare serum levels of cytokines between the patient group and control group; binary logistic regression was used to investigate factors independently related to the severity of pemphigus vulgaris; a receiver operating characteristic （ROC） curve was drawn, and the area under the curve, sensitivity and specificity were calculated to evaluate the ability of YKL-40 to predict the severity of pemphigus vulgaris. Results Compared with the control group, the patient group showed significantly increased serum levels of YKL-40 （expressed as median ［Q1, Q3］: 15.22 ［14.19, 15.93］ vs. 13.64 ［13.21, 14.63］ μg/L, z = -3.88, P < 0.05）, interleukin （IL）-6 （2.05 ［1.49, 4.21］ vs. 1.57 ［1.38, 1.75］ ng/L, z = -2.44, P < 0.05）, IL-7 （7.45 ［5.63，11.63］ vs. 3.77 ［2.21, 5.97］ ng/L, z = -3.26, P < 0.05］, IL-8 （6.59［3.60, 14.73］ vs. 4.36 ［2.96, 6.53］ ng/L, z = -1.96, P < 0.05）, IL-2R-α （509.08 ［386.36, 757.67］ vs. 336.44 ［309.86, 458.71］ ng/L, z = -2.35, P < 0.05）, and C5a （100.35 ［78.31, 140.84］ vs. 72.08 ［37.23, 82.08］ ng/L, z = -3.04, P < 0.05）. The concentration of serum YKL-40 gradually decreased along with the reduction of lesion areas （r = 0.634, P < 0.001）, and YKL-40 was independently correlated with the severity of pemphigus vulgaris （P = 0.025, OR = 46.54, 95% CI: 1.61, 1 347.19）. The area under the curve of YKL-40 was 0.783 （95% CI: 0.613, 0.953） for distinguishing between patients with severe to extremely severe pemphigus vulgaris and those with mild to moderate pemphigus vulgaris. Conclusion The serum level of YKL-40 is strongly correlated with the severity of pemphigus vulgaris, and has a potential value in predicting the severity of this disease.

Key words: Pemphigus, Chitinase, Severity of illness index, Biological markers, Th2 cells, Cytokines, Chitinase-3-like protein 1