Rothkrantz-Kos Snjezana, van Dieijen-Visser Marja P, Mulder Paul G H, Drent Marjolein
Department of Clinical Chemistry, Sarcoidosis Management Center, University Hospital Maastricht, and Nutrition and Toxicology Research Institute Maastricht (NUTRIM), University Maastricht, The Netherlands.
Clin Chem. 2003 Sep;49(9):1510-7. doi: 10.1373/49.9.1510.
Sarcoidosis is a multiorgan inflammatory granulomatous disorder of unknown origin for which adequate markers to monitor disease severity are lacking. The aim of this study was to evaluate the potential clinical usefulness of serologic markers of inflammation [high-sensitivity C-reactive protein (hs-CRP) and serum amyloid A (SAA)], T-cell activation [soluble interleukin-2 receptor (sIL2R)], and granuloma formation [angiotensin-converting enzyme (ACE)] for monitoring of sarcoidosis.
Of the 185 sarcoidosis patients who visited the Sarcoidosis Management Center between 1999 and 2002, we selected 144 nonsmoking patients: 73 untreated (group I) and 71 treated (group II). Subgroups of the untreated patients [group Ia (nonchronic group with time since diagnosis < or = 2 years) and group Ib (chronic group with time since diagnosis >2 years)] were evaluated separately. ROC curves and logistic regression analyses were used to compare the diagnostic accuracy of different markers to assess disease severity. Pulmonary disease severity was defined by lung function test results.
In untreated subgroup Ia and the total untreated group (group I), sIL2R had the largest areas under the curves (AUCs; 0.891 and 0.799, respectively) and the highest sensitivity (82% and 64%), specificity (94% and 88%), and positive (82% and 70%) and negative (94% and 88%) predictive values among the evaluated markers in both untreated groups. Nevertheless, the confidence intervals for sIL2R AUC, sensitivity, and specificity were broad and partly overlapped those of ACE, hs-CRP, and SAA. In the treated group (group II), all four markers appeared to have comparable AUCs, ranging from 0.645 for SAA to 0.711 for sIL2R.
sIL2R appears to be useful for monitoring respiratory disease severity in sarcoidosis. We recommend sIL2R measurement in the follow-up of patients with sarcoidosis.
结节病是一种病因不明的多器官炎症性肉芽肿疾病，目前缺乏用于监测疾病严重程度的合适标志物。本研究旨在评估炎症血清学标志物[高敏C反应蛋白（hs-CRP）和血清淀粉样蛋白A（SAA）]、T细胞活化标志物[可溶性白细胞介素-2受体（sIL2R）]以及肉芽肿形成标志物[血管紧张素转换酶（ACE）]在结节病监测中的潜在临床应用价值。
在1999年至2002年间就诊于结节病管理中心的185例结节病患者中，我们选取了144例不吸烟患者：73例未接受治疗（I组）和71例接受治疗（II组）。未治疗患者的亚组[Ia组（诊断后时间≤2年的非慢性组）和Ib组（诊断后时间>2年的慢性组）]分别进行评估。采用ROC曲线和逻辑回归分析比较不同标志物评估疾病严重程度的诊断准确性。肺部疾病严重程度由肺功能测试结果定义。
在未治疗的Ia亚组和整个未治疗组（I组）中，sIL2R在评估的标志物中曲线下面积最大（分别为0.891和0.799），敏感性最高（分别为82%和64%）、特异性最高（分别为94%和88%）、阳性预测值（分别为82%和70%）和阴性预测值（分别为94%和88%）。然而，sIL2R曲线下面积、敏感性和特异性的置信区间较宽，部分与ACE、hs-CRP和SAA的置信区间重叠。在治疗组（II组）中，所有四种标志物的曲线下面积似乎相当，从SAA的0.645到sIL2R的0.711。
sIL2R似乎对监测结节病的呼吸道疾病严重程度有用。我们建议在结节病患者的随访中检测sIL2R。
