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（n33）和TAO静止期组（n22）。同期纳入30例健康志愿者30只眼为健康对照组（n30）。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Pα1-AT浓度与CAS评分呈显著正相关（r0.846，P0.000）。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（AUC0.959，P0.05），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。

Objective · To investigate the and clinical significance of α1-antitrypsin (α1-AT) in tears of thyroid-associated ophthalmopathy (TAO) patients. Methods · Patients diagnosed with TAO at Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine January to December 2019 were included and divided into active TAO group (n33) and inactive TAO group (n22). Thirty eyes of 30 healthy volunteers were included (n30). Unstimulated tear samples were collected all subjects and the concentration of α1-AT was analyzedenzyme-linked immunosorbent assay (ELISA). Difference of α1-AT concentration among 3 groups was comparedusing 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 analyzedSpearman relation. Statistical significance was accepted at a value of PResults · α1-AT was significantly higher in active TAO group than that in inactive TAO group and control group (both Pr0.846, P0.000). 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% (AUC0.959, PConclusion · 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.