Association between novel cardiac injury marker YKL ⁃ 40 and myocardial fibrosis of idiopathic inflammatory myopathy：accessed by 3.0 T cardiac magnetic resonance
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摘要:
目的：运用 3.0 T 心脏磁共振（cardiac magnetic resonance，CMR）对特发性炎症性肌病（idiopathic inflammatory myopa- thy，IIM）心肌纤维化进行定量检测，并分析与心脏损伤标志物几丁质酶3样蛋白1（chitinase-3-like protein 1，YKL-40）的关系，从而探究血清YKL-40在反映IIM心肌损伤患者心肌纤维化程度中的价值。方法：回顾性纳入2018年5月—2022年8月在南京医科大学第一附属医院就诊的IIM患者64例。所有患者均行3.0T CMR扫描并测定血清YKL-40。采用Student’s t检验、Mann- Whitney U检验或χ2 检验比较心肌损伤组与无心肌损伤组各指标差异；采用Spearman相关分析和线性回归分析IIM患者血清 YKL-40与CMR参数间的关系。使用受试者工作特征（receiver operating characteristic，ROC）曲线评估YKL-40预测IIM患者心肌纤维化的价值。结果：与无心肌损伤患者相比，IIM合并心肌损伤患者年龄［（53.0±13.0）岁 vs.（44.6±16.1）岁］、血清YKL-40 ［73.4（46.9，119.3）ng/mL vs. 48.1（22.5，65.1）ng/mL］、初始T1值（native T1）［（1 263.2±50.3）ms vs.（1 221.8±59.3）ms］及细胞外容积比例（extracellular volume，ECV）［（31.7±5.6）% vs.（28.7±3.2）%］更高，左心室心搏输出量指数（left ventricular stroke volume in- dex，LVSVI）更低［（42.3±10.2）mL/m2 vs.（49.0±11.1）mL/m2 ］（均P＜0.05）。血清YKL-40与ECV（r=0.373，P=0.004）呈正相关。多元线性回归分析示血清YKL-40与ECV独立相关。YKL-40>68 ng/mL（AUC=0.71，95%CI：0.58~0.84）预测IIM患者心肌纤维化，灵敏度为0.62，特异性为0.86。结论：血清YKL-40可以反映IIM心肌损伤患者的心肌纤维化程度。
Abstract:
Objective：The current study aims to quantitatively detect myocardial fibrosis of idiopathic inflammatory myopathy（IIM） by 3.0 T cardiac magnetic resonance（CMR），and to analyze the association between myocardial fibrosis of IIM and cardiac injury marker chitinase-3-like protein 1（YKL-40），to explore the value of serum YKL-40 in reflecting the degree of myocardial fibrosis in IIM patients with myocardial injury. Methods：A total of 64 IIM patients who visited the First Affiliated Hospital of Nanjing Medical University between May 2018 and August 2022 were retrospectively included. All patients underwent 3.0T CMR scan and the expression level of serum YKL -40 was measured. We used Student’s t test，Mann -Whitney U test or chi square test to compare the difference of each index between the myocardial injury group and the non-myocardial injury group；Spearman correlation analysis and linear regression were used to analyze the association between serum YKL-40 and CMR parameters in IIM patients. Receiver-operating characteristic（ROC）curve was used to assess the value of YKL-40 in predicting myocardial fibrosis in IIM patients. Results： Compared with patients without myocardial injury，IIM patients with myocardial injury had higher age［（53.0 ± 13.0）year vs.（44.6 ±16.1）year］，serum YKL-40 expression level［73.4（46.9，119.3）ng/mL vs. 48.1（22.5，65.1）ng/mL］，native T1［（1 263.2 ± 50.3）ms vs. （1221.8 ± 59.3）ms］，and extracellular volume（ECV）［（31.7 ± 5.6）% vs.（28.7 ± 3.2）%］，but the left ventricular stroke volume index （LVSVI）was lower［（42.3 ± 10.2）mL/m2vs.（49.0 ± 11.1）mL/m2 ］（all P < 0.05）. Serum YKL-40 was positively correlated with ECV（r= 0.373，P=0.004）. Multiple linear regression analysis showed that serum YKL-40 was independently correlated with ECV. YKL -40> 68ng/mL（AUC=0.71，95% CI 0.58~0.84）predicted myocardial fibrosis in IIM with a sensitivity of 0.62 and specificity of 0.86. Conclusion：Serum YKL-40 may reflect the degree of myocardial fibrosis in IIM patients with myocardial injury.
