Versura Piera, Giannaccare Giuseppe, Vukatana Gentiana, Mulè Rita, Malavolta Nazzarena, Campos Emilio C
1 Ophthalmology Unit, DIMES, University of Bologna, Bologna, Italy.
2 Rheumatology Unit, S.Orsola-Malpighi Teaching Hospital, Bologna, Italy.
Ann Clin Biochem. 2018 Sep;55(5):561-570. doi: 10.1177/0004563217750679. Epub 2018 Jan 30.
Background The contribution of tear protein expression in patients with presumed diagnosis of Sjögren syndrome is underestimated. We aimed to evaluate the role of tear proteins in the Sjögren syndrome early diagnosis. Methods Charts from 110 patients suspected of Sjögren syndrome were analysed and the subsequent diagnosis retrieved. Subjective symptoms (ocular surface disease index, OSDI), tear film break-up time (TFBUT), Schirmer test, Jones test, tear clearance (TC), corneal (NEI score) and conjunctival staining (van Bjerstelveldt score), esthesiometry, cytology, tear protein analysis (total protein [TP] content, lysozyme-C [LYS-C], lactoferrin [LACTO], lipocalin-1 [LIPOC-1] and albumin [ALB]) were analysed. The diagnostic performance with area under the curve (AUC) and odds ratio (OR) for each parameter were calculated. Results Thirty-five patients (31.8%) had been diagnosed as affected by Sjögren syndrome. Clinical tests showed lower diagnostic performance (OSDI > 44 [AUC 0.57], Schirmer ≤ 5 mm [0.59], TFBUT ≤ 3 s [0.72], TC > 1/16 [0.68], Jones ≤ 4 mm [0.68], corneal staining > 2 [0.51], conjunctival staining > 2 [0.78]) compared with tear proteins (LYS-C ≤ 1.5 mg/mL [0.79], LACTO ≤ 20% [0.94], LIPOC-1 ≤ 10% [0.89], ALB ≥ 15% [0.79]). LYS-C, LACTO, LIPOC-1 and ALB showed a significant association in predicting Sjögren syndrome vs. not-Sjögren syndrome dry eye (OR, respectively, 4.9, 5.5, 7.2, 6.7). Conclusions Tear proteins' concentrations showed a significant higher accuracy compared with the traditional ocular clinical tests for reaching Sjögren syndrome's diagnosis. In particular, LACTO and LIPOC-1 provided an excellent diagnostic performance and thus could likely be considered promising biomarkers of Sjögren syndrome.
背景 疑似干燥综合征患者泪液蛋白质表达的作用被低估。我们旨在评估泪液蛋白质在干燥综合征早期诊断中的作用。方法 分析110例疑似干燥综合征患者的病历，并获取后续诊断结果。分析主观症状（眼表疾病指数，OSDI）、泪膜破裂时间（TFBUT）、泪液分泌试验、琼斯试验、泪液清除率（TC）、角膜（NEI评分）和结膜染色（范·比耶尔斯特尔费尔德评分）、感觉测量、细胞学、泪液蛋白质分析（总蛋白[TP]含量、溶菌酶-C[LYS-C]、乳铁蛋白[LACTO]、脂钙蛋白-1[LIPOC-1]和白蛋白[ALB]）。计算每个参数的曲线下面积（AUC）和比值比（OR）的诊断性能。结果 35例患者（31.8%）被诊断为患有干燥综合征。与泪液蛋白质（LYS-C≤1.5mg/mL[0.79]、LACTO≤20%[0.94]、LIPOC-1≤10%[0.89]、ALB≥15%[0.79]）相比，临床检查显示诊断性能较低（OSDI>44[AUC 0.57]、泪液分泌试验≤5mm[0.59]、TFBUT≤3s[0.72]、TC>1/16[0.68]、琼斯试验≤4mm[0.68]、角膜染色>2[0.51]、结膜染色>2[0.78]）。LYS-C、LACTO、LIPOC-1和ALB在预测干燥综合征与非干燥综合征干眼方面显示出显著相关性（OR分别为4.9、5.5、7.2、6.7）。结论 与传统眼部临床检查相比，泪液蛋白质浓度在诊断干燥综合征方面显示出显著更高的准确性。特别是，LACTO和LIPOC-1具有出色的诊断性能，因此很可能被视为干燥综合征有前景的生物标志物。
