Lili Jiang1,2, Youlian Wang2, Qinglin Peng3, Xiaoming Shu3, Guochun Wang4, Xiaomu Wu5,6. 1. Department of Medicine, Nanchang University, Nanchang, 330006, Jiangxi Province, China. 2. Department of Rheumatology, Jiangxi Provincial People's hospital, Nanchang, 330006, Jiangxi, China. 3. Department of Rheumatology, China-Japan Friendship Hospital, Beijing, 100029, China. 4. Department of Rheumatology, China-Japan Friendship Hospital, Beijing, 100029, China. guochunwang@hotmail.com. 5. Department of Medicine, Nanchang University, Nanchang, 330006, Jiangxi Province, China. wuxm79@163.com. 6. Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, 330006, Jiangxi, China. wuxm79@163.com.
Abstract
OBJECTIVE: We aimed to investigate the clinical value of checking serum chitinase-3-like-1 protein (YKL-40) levels in anti-MDA5 antibody-positive dermatomyositis (anti-MDA5+DM) patients. METHODS: One hundred and five consecutive anti-MDA5+DM patients and 44 healthy controls were enrolled in this study. Baseline and follow-up serum YKL-40 were detected by ELISA. We evaluated the association of YKL-40 with rapidly progressive interstitial lung disease (RPILD), severity of interstitial lung disease (ILD), and ILD-related survival. RESULTS: Forty-one out of 105 anti-MDA5+DM patients had RPILD at the time of serum sample collection (39.0%). Serum YKL-40 levels were significantly higher in anti-MDA5+DM patients with RPILD compared with those without (p = 0.011). One month after treatment, patients with aggravated ILD had increased YKL-40 levels, while those with stable/improved ILD had decreased YKL-40 levels. Higher serum levels of ferritin and YKL-40, as well as lower peripheral CD3+T cell counts, were independently associated with poorer prognosis. Kaplan-Meier survival curve showed that the 6 months survival rate in patients with high serum YKL-40 level (> 80 ng/ml) was significantly lower than that in patients with low YKL-40 level (≤ 80 ng/ml) (67% vs 89%, p < 0.01). CONCLUSION: YKL-40 can be useful as an indicator for the occurrence of RPILD and correlates with severity of ILD and poor prognosis in anti-MDA5+DM patients. Closely monitoring and intensive treatment are suggested in anti-MDA5+DM patients showing high level of YKL-40, especially levels > 80 ng/ml.
OBJECTIVE: We aimed to investigate the clinical value of checking serum chitinase-3-like-1 protein (YKL-40) levels in anti-MDA5 antibody-positive dermatomyositis (anti-MDA5+DM) patients. METHODS: One hundred and five consecutive anti-MDA5+DMpatients and 44 healthy controls were enrolled in this study. Baseline and follow-up serum YKL-40 were detected by ELISA. We evaluated the association of YKL-40 with rapidly progressive interstitial lung disease (RPILD), severity of interstitial lung disease (ILD), and ILD-related survival. RESULTS: Forty-one out of 105 anti-MDA5+DMpatients had RPILD at the time of serum sample collection (39.0%). Serum YKL-40 levels were significantly higher in anti-MDA5+DMpatients with RPILD compared with those without (p = 0.011). One month after treatment, patients with aggravated ILD had increased YKL-40 levels, while those with stable/improved ILD had decreased YKL-40 levels. Higher serum levels of ferritin and YKL-40, as well as lower peripheral CD3+T cell counts, were independently associated with poorer prognosis. Kaplan-Meier survival curve showed that the 6 months survival rate in patients with high serum YKL-40 level (> 80 ng/ml) was significantly lower than that in patients with low YKL-40 level (≤ 80 ng/ml) (67% vs 89%, p < 0.01). CONCLUSION:YKL-40 can be useful as an indicator for the occurrence of RPILD and correlates with severity of ILD and poor prognosis in anti-MDA5+DMpatients. Closely monitoring and intensive treatment are suggested in anti-MDA5+DMpatients showing high level of YKL-40, especially levels > 80 ng/ml.
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