上海交通大学学报(医学版)

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甲状腺相关眼病泪液α1-抗胰蛋白酶的表达量及临床意义

吴 钰 *,鲁 奕 *,孙 柔,张 硕,孙 静,周慧芳 #,范先群 #   

  1. 上海交通大学医学院附属第九人民医院眼科,上海市眼眶病眼肿瘤重点实验室,上海 200011
  • 出版日期:2020-04-25 发布日期:2020-04-25
  • 通讯作者: 范先群,电子信箱:fanxq@sjtu.edu.cn。周慧芳,电子信箱:fangzzfang@163.com。# 为共同通信作者。
  • 作者简介:吴 钰(1994—),女,博士生;电子信箱:wuyu940404@163.com。鲁 奕(1995—),男,硕士生;电子信箱:798723468@qq.com。* 为共同第一作者。
  • 基金资助:
    国家自然科学基金重点项目(81970974);国家自然科学基金面上项目(81770974);国家自然科学基金青年项目(81800695);上海交通大学医学院多中心临床研究项目(DYL201615);上海市青年科技英才扬帆计划(18YF1412300)。

Expression and clinical significance of α1-antitrypsin in thyroid-associated ophthalmopathy

WU Yu, LU Yi, SUN Rou, ZHANG Shuo, SUN Jing, ZHOU Hui-fang, FAN Xian-qun   

  1. Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China.
  • Online:2020-04-25 Published:2020-04-25
  • Contact: FAN Xian-qun, E-mail: fanxq@sjtu.edu.cn. ZHOU Hui-fang, E-mail: fangzzfang@163.com. #Co-corresponding authors.
  • Supported by:
    National Natural Science Foundation of China (81970974, 81770974, 81800695); the Multicenter Clinical Research Program of Shanghai Jiao Tong University School of Medicine (DYL201615); Shanghai Youth Science and Technology Talents Sailing Plan (18YF1412300).

摘要: 目的 · 探索甲状腺相关眼病(thyroid-associated ophthalmopathy,TAO)泪液中 α1- 抗胰蛋白酶(α1-antitrypsin,α1-AT)的表达量及其临床意义。方法 · 纳入 2019 年 1—12 月就诊于上海交通大学医学院附属第九人民医院的 30 例 TAO 患者共 55 只患眼,分为 TAO 活动期组(n=33)和 TAO 静止期组(n=22)。同期纳入 30 例健康志愿者 30 只眼为健康对照组(n=30)。采集全部研究对象的非刺激性泪液,用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)测定泪液中 α1-AT 的浓度。3 组间浓度差异采用 Kruskal-Wallis H 检验,进一步的组间比较采用 Mann-Whitney U 检验,α1-AT 浓度与临床活动性评分(clinical activity score,CAS)的相关性采用 Spearman 相关分析。P<0.05 为差异有统计学意义。结果 · TAO 活动期组的泪液中 α1-AT 水平明显高于 TAO 静止期组与健康对照组(均 P<0.05),TAO 静止期组与健康对照组组间差异无统计学意义。TAO 患者泪液 α1-AT 浓度与 CAS 评分呈显著正相关(r=0.846,P=0.000)。接受者操作特征曲线(receiver operating characteristic curve,ROC curve)表明,α1-AT 浓度 939.48ng/mL 作为临界值诊断 TAO 活动性,有较高的诊断价值(AUC=0.959,P<0.05),敏感度为 81.8%,特异度为 100%。结论 · TAO 活动期泪液α1-AT 浓度显著上升,泪液 α1-AT 水平可作为评估 TAO 活动性分期的有效指标。
【该文已在2020年04期正式发表】

关键词: 甲状腺相关眼病, 泪液, α1- 抗胰蛋白酶, 酶联免疫吸附试验

Abstract: Objective · To investigate the expression and clinical significance of α1-antitrypsin (α1-AT) in tears of thyroid-associated ophthalmopathy (TAO) patients. Methods · Patients diagnosed with TAO at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January to December 2019 were included and divided into active TAO group (n=33) and inactive TAO group (n=22). Thirty eyes of 30 healthy volunteers were included (n=30). Unstimulated tear samples were collected from all subjects and the concentration of α1-AT was analyzed by enzyme- linked immunosorbent assay (ELISA). Difference of α1-AT concentration among 3 groups was compared by using Kruskal-Wallis H test. Mann-Whitney U test was performed for further comparison between each 2 groups. Correlationship between α1-AT concentration and clinical activity score (CAS) was analyzed by Spearman relation. Statistical significance was accepted at a value of P<0.05. Results · α1-AT was significantly higher in active TAO group than that in inactive TAO group and control group (both P<0.05). There was no significant difference in α1-AT between inactive TAO group and control group. Tear α1-AT level was significantly correlated with CAS (r=0.846, P=0.000). ROC curve showed that the optimal diagnostic cut off value of α1-AT was 939.48 ng/mL, and the sensitivity and specificity were 81.8% and 100% (AUC=0.959, P<0.05). Conclusion · α1-AT is significantly elevated in the tears of active TAO patients. Tear α1-AT level has important value in the diagnosis of clinical activity of TAO.

Key words: thyroid-associated ophthalmopathy (TAO), tears, α1-antitrypsin (α1-AT), enzyme-linked immunosorbent assay (ELISA)