标题：血清25(OH)D、YKL-40水平与肾综合征出血热患者疾病进程及预后的关系研究

      作者：刘改 1，代薇 1，代坤 2，    1.西安市第八医院检验科，陕西 西安 710061；2.西安市阎良铁路医院检验科，陕西 西安 710089

      卷次： 2023年34卷17期

      【摘要】 目的 探讨25羟维生素D[25(OH)D]、甲壳质酶蛋白 40 (YKL-40)在肾综合征出血热(HFRS)患者中的表达及其与疾病进程及预后的相关性。方法 选取 2021年 1月至 2022年 6月西安市第八医院收治的 170例HFRS患者作为研究组，根据临床分型标准将其分为轻型组、中型组、重型组和危重型组，以住院期间及出院后28 d疾病转归界定预后(存活或死亡)。此外，选取在本院体检的健康志愿者150例作为对照组。收集所有受检者的一般资料，采用酶联免疫吸附法检测血清中25(OH)D、YKL-40表达水平，采用Spearman相关分析用于评估25(OH)D、YKL-40与疾病进程之间的相关性，采用Pearson相关分析用于评估25(OH)D、YKL-40与常规实验室参数之间的相关性；利用受试者工作特征曲线(ROC)分析25(OH)D、YKL-40水平对患者预后的诊断价值。结果 研究组患者的血清25(OH)D表达水平为(12.39±2.24) ng/mL，明显低于对照组的(23.66±6.25) ng/mL，YKL-40表达水平为(48.36±6.31) ng/mL，明显高于对照组的(32.55±3.58) ng/mL，差异均有统计学意义(P<0.05)；轻型组患者的血清25(OH)D、YKL-40表达水平分别为(17.71±2.88) ng/mL、(36.29±5.05) ng/mL，中型组分别为(13.58±2.61) ng/mL、(43.48±5.91) ng/mL，重型组分别为(10.33±1.91) ng/mL、(52.85±6.70) ng/mL，危重型组分别为(8.41±1.59) ng/mL、(60.34±7.53) ng/mL，25(OH)D表达水平随着病变程度的加重逐渐升高，YKL-40表达水平随着病变程度的加重逐渐降低，差异均有统计学意义(P<0.05)；死亡组患者的血清 25(OH)D水平为(5.82±1.59) ng/mL，明显低于存活组的(13.17±2.32) ng/mL，而YKL-40水平为(65.70±8.79) ng/mL，明显高于存活组的(46.31±6.02) ng/mL，差异均具有统计学意义(P<0.05)；经Spearman相关分析法分析结果显示，血清25(OH)D表达水平与血红蛋白、血小板、红细胞、纤维蛋白原(Fib)均呈正相关(P<0.05)，与白蛋白、尿素氮、肌酐、凝血酶原时间(PT)、D-二聚体(DD)表达均呈负相关(P<0.05)，而血清YKL-40水平与血红蛋白、血小板、红细胞、Fib均呈负相关 (P<0.05)，与白蛋白、尿素氮、肌酐、PT、DD均呈正相关 (P<0.05)；经ROC分析结果显示，血清YKL-40、25(OH)D水平预测患者预后的AUC分别为 0.897 (敏感度为 88.89%、特异度为85.53%)、0.913 (敏感度为83.33%、特异度为94.08%)，两者联合检测的AUC为0.935、敏感度为94.44%、特异度为88.82%。结论 25(OH)D在HFRS患者血清中呈低表达，YKL-40呈高表达，两者表达与患者疾病进程及预后密切相关。
      【关键词】 肾综合征出血热；25羟维生素D；甲壳质酶蛋白40；疾病进程；预后
      【中图分类号】 R692 【文献标识码】 A 【文章编号】 1003—6350（2023）17—2527—05

Relationship between serum 25(OH)D and YKL-40 levels and disease progression and prognosis in patients ofhemorrhagic fever with renal syndrome.
LIU Gai 1, DAI Wei 1, DAI Kun 2. 1. Department of Clinical Laboratory, Xi'anEighth Hospital, Xi'an 710061, Shaanxi, CHINA; 2. Department of Clinical Laboratory, Xi'an Yanliang Railway Hospital,Xi'an 710089, Shaanxi, CHINA
【Abstract】 Objective To investigate the expression of 25-hydroxyvitamin D [25(OH)D] and chitinase protein40 (YKL-40) in patients of hemorrhagic fever with renal syndrome (HFRS) and their correlation with disease progres-sion and prognosis. Methods From January 2021 to June 2022, 170 HFRS patients admitted to Xi'an Eighth Hospitalwere selected as the study group. According to the clinical classification criteria, the patients were divided into mildgroup, moderate group, severe group, and critical group, and the prognosis (survival or death) was defined by disease out-come during hospitalization and 28 days after discharge. Another 150 volunteers who underwent physical examination inthe hospital were enrolled as the control group. General data of all subjects were collected, and the expression levels of25(OH)D and YKL-40 in serum were detected by enzyme-linked immunosorbent assay (ELISA). Spearman correlationanalysis was used to evaluate the correlation between 25(OH)D, YKL-40 and disease progression, and Pearson correla-tion analysis was used to evaluate the correlation between 25(OH)D, YKL-40 and conventional laboratory parameters.Receiver operating characteristic curve (ROC) was used to analyze the prognostic value of YKL-40 and 25(OH)D levelsin patients. Results The expression level of serum 25(OH)D in the study group was (12.39±2.24) ng/mL, which waslower than (23.66±6.25) ng/mL of the control group; and the expression level of YKL-40 was (48.36±6.31) ng/mL,which was significantly lower than (32.55±3.58) ng/mL of the control group; the differences were statistically significant(P<0.05). The expression levels of serum 25(OH)D and YKL-40 in the mild group were (17.71 ± 2.88) ng/mL and(36.29±5.05) ng/mL, respectively, (13.58±2.61) ng/mL and (43.48±5.91) ng/mL in moderate group, (10.33±1.91) ng/mLand (52.85±6.70) ng/mL in severe group, (8.41±1.59) ng/mL and (60.34±7.53) ng/mL in critical group, respectively; theexpression level of 25(OH)D gradually increased with the severity of the lesion, while the expression level of YKL-40decreased with the severity of the lesions; the differences were statistically significant (P<0.05). The serum 25(OH)D lev-el in the death group was (5.82±1.59) ng/mL, which was significantly lower than (13.17±2.32) ng/mL in the survivalgroup, while the YKL-40 level was (65.70±8.79) ng/mL, which was significantly higher than (46.31±6.02) ng/mL in thesurvival group, with statistically significant differences (P<0.05). The results of Spearman analysis showed that the ex-pression level of serum 25(OH)D was positively correlated with hemoglobin, platelets, erythrocytes, and fibrinogen(Fib) (P<0.05) and negatively correlated with albumin, urea nitrogen, creatinine, prothrombin time (PT), and D-dimer(DD) expression (P<0.05), while serum YKL-40 level was negatively correlated with hemoglobin, platelets, erythrocytes,and Fib (P<0.05) and positively correlated with albumin, urea nitrogen, creatinine, PT, and DD (P<0.05). ROC curve anal-ysis showed that the AUC of serum YKL-40 and 25(OH)D levels in predicting prognosis of patients were 0.897 (sensitivi-ty: 88.89%, specificity: 85.53%) and 0.913 (sensitivity: 83.33%, specificity: 94.08%), respectively. The AUC of combineddetection was 0.935, with the sensitivity of 94.44% and the specificity of 88.82%. Conclusion 25(OH)D is lowly ex-pressed in the serum of HFRS patients, and YKL-40 is highly expressed. The expression of the two are closely related tothe disease process and prognosis of the patients.
      【Key words】 Hemorrhagic fever with renal syndrome; 25-hydroxyvitamin D [25(OH)D]; Chitinase protein 40(YKL-40); Disease process; Prognosis