目的探讨放射治疗后血清YKL-40变化对乳腺癌患者预后判断的价值。方法采用抽签法随机选取2011年6月至2012年12月在甘肃省肿瘤医院乳腺科门诊进行乳腺癌筛查确诊为健康者30例(健康对照组),以及就诊于放射治疗科的100例乳腺癌患者进行前瞻性研究。采用ELISA法检测健康对照组及乳腺癌患者放射治疗前后血清YKL-40水平。采用独立样本t检验比较健康对照组与抽签法随机抽取的30例乳腺癌患者之间,以及100例乳腺癌患者放射治疗前或放射治疗后CEA、CA153阳性与阴性患者之间YKL-40水平的差异;采用配对t检验比较CEA、CA153阳性或阴性乳腺癌患者放射治疗前与放射治疗后血清YKL-40水平的差异。并且,放射治疗后血清YKL-40升高者与降低者局部复发率及远处转移率的比较采用χ~2检验,生存曲线绘制采用Kaplan-Meier法,生存率比较采用Log-rank检验。结果(1)30例乳腺癌患者放射治疗前后血清YKL-40水平分别为(104.21±22.07)ng/ml和(90.14±23.85)ng/ml,均高于健康对照组的(49.04±9.61)ng/ml(t=12.491、8.673,P均<0.001)。100例乳腺癌患者放射治疗前后血清YKL-40水平分别为(102.17±22.04)ng/ml和(91.67±29.18)ng/ml,放射治疗后血清YKL-40水平逐步下降(t=4.002,P<0.001)。(2)CEA和CA153阳性患者血清YKL-40水平在放射治疗后较放射治疗前均明显降低[CEA:(87.26±30.28)ng/ml比(107.23±25.54)ng/ml,CA153:(77.52±31.01)ng/ml比(108.12±19.95)ng/ml,t=5.443、4.750,P均<0.001]。(3)无论是放射治疗前,还是放射治疗后,CEA阳性患者与阴性患者血清YKL-40水平均接近(t=1.414、-0.992,P=0.164、0.523);而在放射治疗后,CA153阳性患者血清YKL-40水平却明显低于CA153阴性者[(77.52±31.01)ng/ml比(95.90±27.42)ng/ml,t=-2.559,P=0.015]。(4)在100例乳腺癌患者中,88例患者放射治疗后血清YKL-40水平较放射治疗前降低,12例患者放射治疗后血清YKL-40水平较放射治疗前升高。中位随访36个月(24~48个月),血清YKL-40降低者局部复发率、远处转移率分别为18.6%(16/88)和13.6%(12/88),均明显低于血清YKL-40升高者的66.7%(8/12)和50%(6/12)(χ~2=11.081、7.157,P=0.001、0.007)。放射治疗后血清YKL-40升高者1、2、3年OS率分别为91.7%、83.3%、66.7%,而血清YKL-40降低者1、2、3年OS率分别为97.7%、93.2%、86.4%。血清YKL-40升高者OS率明显低于血清YKL-40降低者(χ~2=4.050,P=0.044)。结论 YKL-40在乳腺癌患者血清中具有较高的表达水平,放射治疗期间联合检测血清YKL-40、CEA和CA153,对患者预后的评判具有一定价值。 Objective To investigate the prognostic value of serum YKL-40 in patients with breast cancer after radiotherapy. Methods Thirty patients (healthy control group) who were diagnosed as breast cancer by breast cancer screening in Gansu Provincial Cancer Hospital from June 2011 to December 2012 were selected randomly from 100 cases of breast cancer Cancer patients were prospectively studied. Serum levels of YKL-40 were measured by ELISA before and after radiotherapy in healthy controls and breast cancer patients. The independent sample t-test was used to compare the levels of YKL-40 between 30 healthy breast cancer patients randomly selected by the healthy control group and randomized patients and 100 patients with breast cancer before or after radiotherapy for CEA and CA153-positive and negative patients The differences of serum YKL-40 level before and after radiotherapy in patients with CEA, CA153 positive or negative breast cancer were compared by paired t-test. And after radiation therapy, the serum levels of YKL-40 were compared with those with lower local recurrence rate and distant metastasis rate by χ ~ 2 test. The survival curve was drawn by Kaplan-Meier method, and the survival rate was compared by Log-rank test. Results (1) The levels of serum YKL-40 in the 30 breast cancer patients before and after radiotherapy were (104.21 ± 22.07) ng / ml and (90.14 ± 23.85) ng / ml respectively, which were significantly higher than those in the healthy controls (49.04 ± 9.61) ng / ml (t = 12.491,8.673, P <0.001). Serum levels of YKL-40 in 100 breast cancer patients before and after radiotherapy were (102.17 ± 22.04) ng / ml and (91.67 ± 29.18) ng / ml, respectively, and the levels of serum YKL- 0.001). (2) The levels of serum YKL-40 in CEA and CA153-positive patients were significantly lower than those before radiotherapy [CEA: (87.26 ± 30.28) ng / ml vs 107.23 ± 25.54 31.01) ng / ml (108.12 ± 19.95) ng / ml, t = 5.443,4.750, P <0.001]. (3) The levels of serum YKL-40 in both CEA-positive and -negative patients were similar before radiotherapy or after radiotherapy (t = 1.414, -0.992, P = 0.164,0.523); after radiotherapy, The level of serum YKL-40 was significantly lower in patients with CA153-negative (77.52 ± 31.01 ng / ml vs 95.90 ± 27.42 ng / ml, t = -2.559, P = 0.015). (4) In 100 cases of breast cancer patients, the level of serum YKL-40 in 88 patients was lower than that before radiation therapy, and the level of serum YKL-40 in 12 patients after radiation therapy was higher than that before radiation therapy. The median follow-up was 36 months (range, 24-48 months). The rates of local recurrence and distant metastasis were 18.6% (16/88) and 13.6% (12/88) in patients with decreased serum YKL-40, respectively, 66.7% (8/12) and 50% (6/12) of patients with elevated serum YKL-40 (χ ~ 2 = 11.081, 7.157, P = 0.001, 0.007). The 1-year, 2-year and 3-year OS rates of patients with elevated YKL-40 after radiotherapy were 91.7%, 83.3% and 66.7%, respectively. The 1, 2 and 3-year OS rates of patients with decreased serum YKL-40 were 97.7% and 93.2% %, 86.4%. The OS rate of patients with elevated serum YKL-40 was significantly lower than that of patients with decreased serum YKL-40 (χ ~ 2 = 4.050, P = 0.044). Conclusion YKL-40 is highly expressed in the serum of patients with breast cancer. Combined detection of serum YKL-40, CEA and CA153 during radiotherapy has a certain value in the prognosis of patients with breast cancer.