Papasavvas Ioannis, Gehrig Béatrice, Herbort Carl P
Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), 1003 Lausanne, Switzerland.
Diagnostics (Basel). 2021 Mar 29;11(4):608. doi: 10.3390/diagnostics11040608.
The diagnosis of ocular sarcoidosis (OS) is difficult to establish in the absence of manifest systemic involvement. To help clinicians reach a diagnosis, we convened a group of experts in 2006 (International Workshop on Ocular Sarcoidosis (IWOS)) to set-up clinical criteria for the diagnosis of ocular sarcoidosis. In addition, laboratory investigational tests represent a much-needed adjunct to ascertain the diagnosis. However, many of these tests have low sensitivity and specificity.
The aim of our study was to evaluate the usefulness of serum ACE, serum lysozyme and polyclonal antibody activation in the diagnosis of ocular sarcoidosis and compare the frequency of increased serum levels of lysozyme and ACE in proven ocular sarcoidosis or in suspected ocular sarcoidosis.
Serum ACE and lysozyme were assessed in these two groups and their means compared to a group of non-granulomatous (i.e., non-sarcoidosis) uveitis patients. The proportion of elevated serum ACE versus lysozyme was compared in the sarcoidosis patients. Polyclonal antibody activation was measured by establishing exposition of patients to four human commensal herpesviruses (EBV, CMV, HSV and VZV) using ELISA or immunofluorescence and in parallel by performing quantitative complement fixation (CF) serologies. The ratio of elevated CF to positive ELISA/immunofluorescence serologies was calculated. The mean of ratios (polyclonal antibody activation) was compared between ocular sarcoidosis and control groups.
Thirty-seven patients (F24/M13) were included in our study including 17 patients with IWOS Level 1 and 2 criteria qualifying for Group 1 (proven sarcoidosis) and 20 ocular sarcoidosis suspect patients. Mean age was 54.52 ± 23.74. Mean serum levels of ACE was 49.17± 29 IU/L in the ocular sarcoidosis group versus 27.4 ± 15.34 IU/L ( ≤ 0.00018, student's t test) in the control group. Mean serum lysozyme levels was 39.92 ± 55.5 mg/L in the ocular sarcoidosis group versus 10.5 ± 5.8 mg/L ( ≤ 0.0013) in the control group ( = 30). Both tests were elevated in 8/37 (21.6%) patients, elevated ACE and normal lysozyme was noted in 2/37 (5.4%) patients, whereas the proportion of normal ACE/elevated lysozyme was much higher, 23/37 (62.2%). In 4/37 (10.8%) patients, both tests were normal. The mean score of polyclonal activation (N of elevated CF serologies divided by number of viruses to which a patient was exposed) was 0.6 ± 0.33 in the ocular sarcoidosis group versus 0.15 ± 0.2 for the control group ( = 42) ( ≤ 0.00001). Sensitivity and specificity of ACE and lysozyme were, respectively, 27%/96.6% and 83.7%/90%. Sensitivity and specificity of polyclonal antibody activation amounted to 70%/90.4% Conclusion: Lysozyme was found to be much more useful than ACE as a laboratory test to support the diagnosis of ocular sarcoidosis. As shown in a previous study, polyclonal antibody activation appears to be another useful laboratory test supportive of the diagnosis of ocular sarcoidosis.
在没有明显全身受累的情况下，眼部结节病（OS）的诊断很难确立。为帮助临床医生做出诊断，我们于2006年召集了一组专家（国际眼部结节病研讨会（IWOS））来制定眼部结节病的临床诊断标准。此外，实验室检查是确诊所急需的辅助手段。然而，这些检查中的许多敏感性和特异性都较低。
我们研究的目的是评估血清血管紧张素转换酶（ACE）、血清溶菌酶和多克隆抗体激活在眼部结节病诊断中的作用，并比较经证实的眼部结节病患者或疑似眼部结节病患者血清溶菌酶和ACE水平升高的频率。
对这两组患者的血清ACE和溶菌酶进行评估，并将其平均值与一组非肉芽肿性（即非结节病）葡萄膜炎患者进行比较。比较结节病患者中血清ACE升高与溶菌酶升高的比例。通过酶联免疫吸附测定（ELISA）或免疫荧光法确定患者对四种人类共生疱疹病毒（EB病毒、巨细胞病毒、单纯疱疹病毒和水痘带状疱疹病毒）的暴露情况来测量多克隆抗体激活，并同时进行定量补体结合（CF）血清学检测。计算CF升高与ELISA/免疫荧光血清学阳性的比例。比较眼部结节病组和对照组的比例平均值（多克隆抗体激活）。
我们的研究纳入了37例患者（女性24例/男性13例），其中17例符合IWOS 1级和2级标准，归入第1组（经证实的结节病），20例为疑似眼部结节病患者。平均年龄为54.52±23.74岁。眼部结节病组血清ACE的平均水平为49.17±29 IU/L，而对照组为27.4±15.34 IU/L（学生t检验，P≤0.00018）。眼部结节病组血清溶菌酶的平均水平为39.92±55.5 mg/L，对照组为10.5±5.8 mg/L（P≤0.0013）（n = 30）。37例患者中有8例（21.6%）两项检查均升高，2例（5.4%）患者ACE升高而溶菌酶正常，而ACE正常/溶菌酶升高的比例更高，为23/37（62.2%）。4例（10.8%）患者两项检查均正常。眼部结节病组多克隆激活的平均评分（CF血清学升高的数量除以患者暴露的病毒数量）为0.6±0.33，对照组为0.15±0.2（n = 42）（P≤0.00001）。ACE和溶菌酶的敏感性和特异性分别为27%/96.6%和83.7%/90%。多克隆抗体激活的敏感性和特异性分别为70%/90.
