重症肌无力患儿血清 YKL-40水平变化及临床意义

目的　观察重症肌无力（myasthenia gravis, MG）患儿血清 YKL-40水平变化情况，探讨其临床意义。方法　收集 2017年 1月 ~2020年 10月在西安医学院第一附属医院治疗的 42例 MG患儿及 50例对照组儿童血液样本。采用 ELISA法检测比较各组血清 YKL-40水平，分析血清 YKL-40水平与定量重症肌无力（ QMG）评分的相关性，探讨 MG患儿血清 YKL-40水平对病情严重程度的评估价值。结果　MG患儿血清 YKL-40水平显著高于对照组（ 83.35±15.26 ng/ml vs 47.75±7.45 ng/ml），差异有统计学意义（ Z=7.823，P＜ 0.001），全身型（Ⅱ a型 + Ⅱ b型）患儿血清 YKL-40水平高于眼肌型（Ⅰ型）患儿，差异有统计学意义（ t=2.214，P＜ 0.05），急性期患儿血清 YKL-40水平明显高于缓解期患儿（ 83.35±17.05ng/ml vs 78.98±17.63ng/ml），差异有统计学意义（ t=7.324，P＜ 0.001）。MG患儿血清 YKL-40水平与 QMG评分呈正相关关系（ r=0.616，P＜ 0.001）。多元线性回归分析结果显示血清 YKL-40水平是 MG患儿 QMG评分的独立影响因素（ Beta=0.659，P＜ 0.001）。ROC曲线分析结果显示血清 YKL-40预测高四分位 QMG评分的曲线下面积为 0.828（0.703，0.953）。结论　MG患儿血清 YKL-40水平升高，可能与 MG急性起病及病情严重程度相关。

Changes of Serum YKL-40 Level in Children with Myasthenia Gravis and Its Clinical Significance

Objective　To investigate the changes of serum YKL-40 level in children with myasthenia gravis (MG) and its clinicalsignificance. Methods　42 MG children and 50 healthy children treated in the First Affiliated Hospital of Xi’an Medical Collegefrom January 2017 to October 2020 were recruited in this study. ELISA was used to detect serum levels of YKL-40. Analyzed thecorrelation between serum YKL-40 level and quantitative myasthenia gravis (QMG) score and explored the value of serum YKL-40 level in evaluating the severity of MG in children. Results　The serum YKL-40 level of MG children was significantly higherthan that of control group （83.35±15.26 ng/ml vs 47.75±7.45 ng/ml）, the difference was statistically significant(Z=7.823, P< 0.001), the serum YKL-40 level of children with systemic type was significantly higher than that of children with eye muscletype, the difference was statistically significant(t=2.214, P=0.033), and the serum YKL-40 level of children with acute stage wassignificantly higher than that of children with remission stage （83.35±17.05ng/ml vs 78.98±17.63ng/ml）, the differencewas statistically significant(t=7.324, P < 0.001). Pearson correlation analysis showed that serum YKL-40 level was significantlypositively related to QMG score (r = 0.616, P ＜ 0.001). Multivariate regression analysis showed that serum YKL-40 was anindependent influencing factor of QMG score for MG children (Beta=0.659, P ＜ 0.001). Based on the ROC curve, the area underthe ROC curve was 0.828(0.703, 0.953) of serum YKL-40 in prediction of highest quartile of QMG score. Conclusion　SerumYKL-40 was highly expressed in MG children, and may be related to the acute onset and severity of MG .