The Expression And Clinical Value Of Serum YKL-40 Level In Patients With Psoriasis

Objective: YKL-40 is a newly discovered inflammation marker that can regulate vascular endothelial growth factor and play an important role in inflammation,cell proliferation and differentiation,angiogenesis,anti-apoptosis and extra-cellular matrix remodeling.This experiment was designed to investigate the expression of YKL-40 in serum of patients with different types of psoriasis and its clinical application value.Methods: We selected the psoriasis vulgaris(PV),psoriatic arthritis(PsA),generalized pustule psoriasis(GPP)and erythrodermic psoriasis(EP)patients from the Department of Dermatology,Wuhan NO.1 Hospital from March 2015 to March 2017;The total patients is 113 cases,including 39 PV cases,22 PsA,22 GPP cases,and EP 30 cases.Another 61 healthy persons who matched age and gender were selected as the control group.All patients with psoriasis and controls received venous blood in the early morning on the first day of admission.Among them,12 patients including 4 GPP patients,5 EP patients and 3 PsA patients performed a second fasting blood test on the day before discharge.The general clinical data of all subjects and PASI scores of patients with psoriasis vulgaris were recorded.Serum YKL-40 levels in all subjects were measured by enzyme-linked immunosorbent assay(ELISA)and clinically relevant indicators were measured including blood glucose,uric acid,triglycerides,total cholesterol,high-density lipoprotein-cholesterol,low-density lipoprotein-cholesterol,total protein,albumin,CRP,ESR,white blood cell count,and neutrophil count.Differences in serum YKL-40 levels between groups,correlations between serum YKL-40 levels and clinically relevant parameters,ROC curve analysis of YKL-40,CRP,and ESR for psoriasis,and differences in YKL-40 levels in different PASI score groups of psoriasis vulgaris patients,and dynamic changes in YKL-40 before and after treatment in psoriasis patients,all of them were analyzed.Results: 1.Comparison of YKL-40 measured concentrations of psoriasis and control group The level of YKL-40 in psoriasis patients was significantly higher than that of the control group.The levels of YKL-40 in EP group,GPP group and PsA group were significantly higher than those in PV group and control group,and EP group is higher than the PsA group;2.Comparison of YKL-40 age-adjusted concentration in psoriasis and control group The YKL-40 age-adjusted concentration in psoriasis was significantly higher than that of control group.YKL-40 age-adjusted concentration in EP,GPP group and PsA group was significantly higher than that of PV group and control group,GPP group was higher than that of PsA group.The difference of YKL-40 age-adjusted concentration between PV group and control group,EP group and GPP group,EP group and PsA group was not statistically significant;3.YKL-40 and clinical indicators correlation analysis.The measured concentration of YKL-40 in psoriasis was positively correlated with CRP,ESR,WBC,NEU,and onset time(P<0.05),and negatively correlated with TP,ALB,A/G,and HDL-C(P<0.05),irrelevant to GLU,UA,TG,TC,and LDL-C(P>0.05),the above correlation still exists after the measured concentration of YKL-40 is adjusted by age.In PsA group,YKL-40 measured concentrations and age-adjusted concentrations were positively correlated with ESR(P<0.05)and negatively correlated with ALB and A/G(P<0.05).In GPP group,YKL-40 measured concentrations and age-adjusted concentrations were positively correlated with ESR and TC(P<0.05)and negatively correlated with ALB and A/G(P<0.05).The measured concentration of YKL-40 was positively correlated with CRP(P<0.05),but after age adjusted,there was no correlation with CRP(P=0.0717).In EP group,YKL-40 measured concentrations and age-adjusted concentrations were positively correlated with CRP and ESR(P<0.05),and negatively correlated with ALB,A/G,and LDL-C(P<0.05);4.ROC curve analysis of YKL-40,CRP and ESR for psoriasis In PsA group,the area under the curve(AUC)of YKL-40 was 0.74,and the AUC of CRP was 0.64,while the AUC for ESR is 0.81,and the AUC for YKL-40 age-adjusted concentrations is 0.77.In GPP group,the AUC for YKL-40,CRP,and ESR were 0.87,0.87,and 0.95,respectively,and the AUC for age-adjusted YKL-40 concentration was 0.93.In EP group,the AUC for YKL-40,CRP,and ESR were 0.89,0.79,and 0.91,respectively,and the AUC for age-adjusted concentrationof YKL-40 was 0.87;5.Comparison of YKL-40 levels in psoriasis vulgaris with different PASI groups.There was no significant difference between measured and age-adjusted concentrationof of YKL-40 in PASI <10 group,10?PASI?20 group,PASI>20 group and control group.6.Dynamic changes of YKL-40 levels and other clinical indicators before and after treatment.Serum YKL-40 levels,CRP,ALB and A/G ratio were significantly changed before and after treatment.But ESR,TP,WBC,and NEU values did not change much before and after treatment.Conclusion: The levels of serum YKL-40 in patients with arthritis psoriasis,generalized pustular psoriasis,and erythrodermic psoriasis were higher than those in healthy controls,and are correlated with clinically relevant indicators.The level of YKL-40 decreased significantly after treatment.These results suggested that YKL-40 may be involved in the pathogenesis of psoriasis and may be used as a new inflammatory marker for the clinical diagnosis,differential diagnosis,and judgment of therapeutic effect of psoriasis.