YKL-40在脑膜瘤患者外周血中的表达及对术后脑水肿加重的影响

目的探讨甲壳质酶蛋白40（YKL-40）在脑膜瘤患者外周血中的表达及对术后脑水肿加重的影响。方法选取2020年1月—2023年1月海南西部中心医院诊治的120例脑膜瘤患者作为观察组，其中术前术后均未出现水肿作为观察Ⅰ组，术前无水肿术后出现水肿作为观察Ⅱ组，术前有水肿术后无加重作为观察Ⅲ组，术前有水肿术后加重作为观察Ⅳ组，同期健康体检者120例作为对照组。对比两组血清YKL-40水平。结果观察组术前、术后3 d、术后7 d、术后14 d血清YKL-40水平显著高于对照组（P＜0.05）；观察组术后3 d血清YKL-40水平高于术前，术后7 d、术后14 d显著降低（P＜0.05）；在不同时间点，观察Ⅰ组至观察Ⅳ组血清YKL-40水平均呈升高趋势（P＜0.05）；120例脑膜瘤患者术后出现脑水肿加重32例，发生率为26.67%（32/120）；Logistic回归模型分析，肿瘤部位在窦镰旁、术前YKL-40水平升高是脑膜瘤患者术后脑水肿加重的危险因素，术前瘤周水肿是脑膜瘤患者术后脑水肿加重的保护因素（P＜0.05）；YKL-40及联合预测模型评估脑膜瘤患者术后脑水肿加重的AUC值分别为0.765、0.854，联合预测模型评估的AUC值高于YKL-40单独评估的AUC值（Z=2.318，P=0.021）；YKL-40连续变化与脑膜瘤患者术后脑水肿加重发生率存在非线性剂量-反应关系（χ2=12.000，P=0.003）。结论脑膜瘤患者外周血YKL-40水平升高，且异常升高的YKL-40与患者术后脑水肿加重有关，提示对于YKL-40＞20 ng/L的患者应警惕术后脑水肿加重的风险。

Objective To investigate the expression of chitinase protein 40(YKL-40) in peripheral blood of patients with meningioma and its effect on postoperative cerebral edema. Methods Total of 120 patients with meningioma diagnosed and treated in Hainan Western Central Hospital from January 2020 to January 2023 were selected as the observation group, and the observation Ⅰ group refered to the patients who had no edema before and after the operation. The observation Ⅱ group refered to the patients who had no edema before the operation but developed edema after the operation. The observation Ⅲ group refered to the patients who had edema before the operation but it did not worsen after the operation. The observation Ⅳ group refered to the patients who had edema before the operation and it worsened after the operation. And 120 healthy subjects served as the control group. The serum YKL-40 levels between the two groups were compared. Results The serum YKL-40 level of the observation group was higher than that of the control group before surgery, 3 d after surgery, 7 d after surgery and 14 d after surgery(P<0.05).The serum YKL-40 level in the observation group was higher than that before surgery at 3 d after surgery, and decreased at 7 d and 14 d after surgery(P<0.05). At different time points, the serum YKL-40 levels in observation groups Ⅰ to Ⅳ showed an increasing trend(P<0.05). Among 120 patients with meningioma, 32 cases showed increased cerebral edema after operation, with an incidence of 26.67%(32/120). Preoperative peritumoral edema was a protective factor for postoperative cerebral edema in patients with meningioma(P<0.05). The tumor site was adjacent to the falx of the sinuses and the increased level of YKL-40 before surgery was a risk factor for the aggravation of postoperative cerebral edema in patients with meningioma, and Preoperative peritumoral edema was a protective factor for postoperative aggravated cerebral edema in patients with meningioma(P<0.05). The AUC values of YKL-40 and combined prediction model for postoperative aggravated cerebral edema in patients with meningioma were 0.765 and 0.854, respectively, and the AUC values evaluated by combined prediction model were higher than those evaluated by YKL-40 alone（Z=2.318，P=0.021）.There was a nonlinear dose-response relationship(χ2=12.000,P=0.003) between the continuous change of YKL-40 and the incidence of postoperative aggravated cerebral edema in meningioma patients. Conclusion The level of YKL-40 in peripheral blood increases in patients with meningioma, and the abnormal increase of YKL-40 was associated with the aggravation of postoperative cerebral edema, suggesting that patients with YKL-40>20 ng/L should be vigilant about the risk of aggravation of postoperative cerebral edema.