目的：探讨几丁质酶-3样蛋白-1（YKL-40）在射血分数保留心力衰竭（HFPEF）患者诊断和评估病情严重程度中的临床价值及阿托伐他汀治疗HFPEF的有效性。方法选择70例HF-PEF患者及35名健康体检者，均于入组时测定血脂及 YKL-40水平，并进行6 min 步行试验（6MWT）。将70例HFPEF患者随机分为阿托伐他汀组35例（在基础治疗上予阿托伐他汀20 mg/d）、对照治疗组35例（仅予基础治疗），并于治疗12个月后再次检测2组患者的血清YKL-40、血脂水平及进行6 MWT。结果治疗前，阿托伐他汀组及对照治疗组患者YKL-40水平均明显高于健康对照组（P＜0.05），且YKL-40水平与6MWT呈负相关（rs ＝-0.999，P＜0.05）。治疗12个月时阿托伐他汀组YKL-40水平比对照治疗组下降更为明显，且6 MWT改善更明显（P均＜0.05）。结论阿托伐他汀能够进一步降低HFPEF患者血清YKL-40水平及改善心功能，YKL-40在评价心功能方面有一定的临床价值。%Objective To evaluate the influence of atorvastatin on serum chitinase-3-like protein-1 (YKL-40)and cardiac function in patients with heart failure with preserved ejection fraction,and investigate the effect of YKL-40 in the diagnosis of HFPEF. Methods Serum YKL-40,serum lipid and 6-minute walk test (6MWT)were measured at baseline in both healthy control group (n=35)and patients with HFPEF (n=70). 70 patients with HFPEF were randomly assigned to control group who received routine therapy,and atorvastatin treatment group who received routine therapy and additional atorvastatin (20 mg/d). Serum YKL-40,lipid profiles and 6MWT were measured after 1 2-month treatment. Results The levels of YKL-40 were significantly higher in patients with HFPEF than healthy control group (P<0.05 ),the level of serum YKL-40 was strong negatively related with 6MWT (rs =-0.999,P<0.05). After 1 2 months treatment,the YKL-40 level in atorvastatin group is significantly reduced than control group (P<0.05 ),and 6 MWT also showed significant better than control group (P<0.05 ). Conclusion Atorvastatin can improve cardiac function and reduce YKL-40 level in patients with HEPEF. YKL-40 could be a prognostic biomarker in patients with HF-PEF.
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