Ishihara Mami, Meguro Akira, Ishido Mizuho, Takeuchi Masaki, Shibuya Etsuko, Mizuki Nobuhisa
Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan.
Clin Ophthalmol. 2020 Aug 12;14:2311-2317. doi: 10.2147/OPTH.S264595. eCollection 2020.
Angiotensin-converting enzyme (ACE) is conventionally used as a biomarker in the diagnosis of uveitis associated with sarcoidosis, but its sensitivity is relatively low. In this study, we investigated whether serum soluble interleukin-2 receptor (sIL-2R) is also useful as a diagnostic marker, in addition to ACE, in the detection of uveitis associated with sarcoidosis.
Data were analyzed from 126 patients with uveitis (52 sarcoidosis and 74 non-sarcoid uveitis) and 12 with primary intraocular lymphoma (PIOL) who had their serum sIL-2R and ACE levels measured.
Serum sIL-2R level was elevated in 69.2% of patients with sarcoid uveitis, 5.4% of those with non-sarcoid uveitis, and 16.7% of those with PIOL. The sensitivity and specificity of an elevated sIL-2R level for the detection of sarcoidosis were 69.2% and 93.0%, respectively. In contrast, serum ACE levels were elevated only in patients with sarcoid uveitis, with a sensitivity of 44.2% and specificity of 100%. Furthermore, serum sIL-2R and/or ACE level was elevated in 75.0% of patients with sarcoid uveitis, which is higher than those who had elevated serum ACE level only (44.2%, = 0.0025). The sensitivity and specificity of elevated sIL-2R and/or ACE in detecting sarcoid uveitis were 75.0% and 93.0%, respectively. The PPV was 0.87, and the NPV was 0.86.
Compared with the sensitivity of serum ACE levels alone, combined measurement of both serum sIL-2R and ACE levels improves sensitivity in the detection of uveitis associated with sarcoidosis. Nevertheless, serum ACE alone remains useful thanks to its high specificity in the differentiation of uveitis patients, with sarcoidosis from those without sarcoidosis.
血管紧张素转换酶（ACE）传统上用作结节病相关性葡萄膜炎诊断的生物标志物，但其敏感性相对较低。在本研究中，我们调查了血清可溶性白细胞介素-2受体（sIL-2R）除ACE外，在检测结节病相关性葡萄膜炎时是否也可用作诊断标志物。
分析了126例葡萄膜炎患者（52例结节病和74例非结节病性葡萄膜炎）以及12例原发性眼内淋巴瘤（PIOL）患者的血清sIL-2R和ACE水平数据。
结节病性葡萄膜炎患者中69.2%的血清sIL-2R水平升高，非结节病性葡萄膜炎患者中5.4%的血清sIL-2R水平升高，原发性眼内淋巴瘤患者中16.7%的血清sIL-2R水平升高。sIL-2R水平升高对检测结节病的敏感性和特异性分别为69.2%和93.0%。相比之下，仅结节病性葡萄膜炎患者的血清ACE水平升高，敏感性为44.2%，特异性为100%。此外，75.0%的结节病性葡萄膜炎患者血清sIL-2R和/或ACE水平升高，高于仅血清ACE水平升高的患者（44.2%，P = 0.0025）。sIL-2R和/或ACE升高检测结节病性葡萄膜炎的敏感性和特异性分别为75.0%和93.0%。阳性预测值为0.87，阴性预测值为0.86。
与单独血清ACE水平的敏感性相比，联合检测血清sIL-2R和ACE水平可提高结节病相关性葡萄膜炎检测的敏感性。然而，单独血清ACE因其在区分葡萄膜炎患者中结节病与非结节病患者方面的高特异性而仍然有用。
