Abstract
YKL-40 is a novel inflammatory protein. Elevated serum levels of YKL-40 have been reported in patients with atherosclerosis and other cardiovascular diseases, but the circulating profile of YKL-40 in patients with cerebrovascular disease has been less investigated. This prospective observational study aimed to determine serum levels of YKL-40 in patients with different subtypes and severities of cerebrovascular disease. Eighty patients with acute ischemic stroke, 30 patients with acute hemorrhagic stroke, 15 patients with transient ischemic attack (TIA) and 18 age- and gender-matched healthy control subjects were recruited. Blood was sampled. Serum levels of YKL-40 were measured by ELISA. In healthy control subjects, serum levels of YKL-40 were 45.09 ± 31.41 ng/ml, significantly lower than those in patients with acute ischemic stroke (178.58 ± 127.78 ng/ml), hemorrhagic stroke (105.32 ± 87.35 ng/ml) and TIA (148.09 ± 108 ng/ml) respectively (P<0.05). When the 80 acute ischemic stroke cases were stratified into four Oxfordshire Community Stroke subtypes, serum levels of YKL-40 were significantly higher in patients with total anterior (n=16), partial anterior (n=25) and posterior (n=12) circulation infarctions respectively than those with lacunar (n=27) infarction (P<0.05). Moreover, 63 of 80 patients with acute ischemic stroke survived. Circulating levels of YKL-40 in these stroke survivors were associated with the United States National Institutes of Health Stroke Scale (NIHSS) scores of neurological deficit. In summary, serum levels of YKL-40 were elevated in patients with cerebrovascular disease in lesion subtype- and severity-dependent manners. These observations suggest a potential for YKL-40 as a diagnostic/prognostic biomarker for cerebrovascular disease.
Highlights
Cerebrovascular disease, often referred to as stroke, is a heterogeneous group of disorders in which areas of the brain are transiently or permanently affected by ischemia or bleeding
We demonstrated that the serum levels of YKL-40 were elevated significantly (p0.05)
Given a previous report that Oxfordshire Community Stroke Project (OCSP) class-different patients are different significantly in mortality, morbidity, length of hospital stay, and complications [23], the association of serum levels of YKL-40 with the OCSP classification observed in the present study suggests that YKL-40 may be useful in predicting the severity of infarct lesions in acute ischemic stroke patients
Summary
Cerebrovascular disease, often referred to as stroke, is a heterogeneous group of disorders in which areas of the brain are transiently or permanently affected by ischemia or bleeding. Stroke-associated burden and death rates vary considerably among countries, depending on the prevalence of cardiovascular disease risk factors and socioeconomic characteristics [1]. In China, stroke claims 1.6 million lives and affects approximately 2.5 million new individuals annually [3], whereby posing a significant health problem. Stroke is believed to be preventable and treatable through management of risk factors; an accurate and timely diagnosis is the key to optimizing the patient outcome [4]. Serum biomarkers have been suggested to play an important role in the diagnosis of acute cerebral ischemia and in the subsequent implementation of timely reperfusion strategies [5]. To date, no reliable biomarkers have been identified and clinically validated for cerebrovascular abnormalities
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