青光眼睫状体炎综合征房水CMVIgG抗体白蛋白校正比值的研究

Determination of cytomegalovirus IgG synthesis by the albumin correction in the aqueous humor of posner-schlossnmtm syndrome

目的研究巨细胞病毒（CMV）免疫球蛋白G（IgG）抗体经白蛋白校正后比值在检测青光眼睫状体炎综合征（PSS）患者房水CMV IgG抗体表达中的应用价值。方法病例对照研究。收集2009年10月至2015年10月在复旦大学附属眼耳鼻喉科医院眼科确诊为PSS患者42例（42只眼）作为病例组，其中男性26例，女性16例，年龄27~71岁。同期收集POAG患者20例作为青光眼对照组，细菌性眼内炎和视网膜坏死共30例作为炎性对照组。3组患者均常规抽取外周血和房水，分别采用ELISA法检测血清及房水中的CMV IgG抗体，散射免疫比浊法检测血清及房水中的白蛋白浓度；PCR检测房水中的CMV脱氧核糖核酸（DNA）。房水和血清CMV IgG抗体测定值经房水和血清白蛋白校正后得出房水CMV IgG校正比值，比值〉0.60认为有眼内抗体生成。以受试者特征曲线评估房水CMV IgG抗体校正比值在CMV DNA阳性PSS组及对照组的诊断效能。采用SPSS Statistics19统计软件进行ANOVA、Mann-Whitney秩和检验及卡方检验。结果PSS组、炎性对照组和POAG组房水CMV IgG抗体的检出率分别为76.2%、100.0%和10.0%，PSS组房水中抗体水平高于POAG组,差异具有统计学意义（Z=4.23，P〈0.01）。3组房水和血清CMV IgG抗体测定值经房水和血清白蛋白校正后，校正比值的阳性率分别为71.4%、3.3%和0.0%，PSS组房水CMV IgG校正比值阳性率高于炎性对照组和POAG组,差异具有统计学意义（χ^2=30.38，P〈0.01；χ^2=24.89，P〈0.01）。校正比值的灵敏度为75.0%，特异度为98.0%，曲线下面积为0.942（95%置信区间，0.859~0.984），高于CMV IgG抗体测定值的曲线下面积（Z=6.19，P〈0.01）。PSS组房水CMV IgG抗体校正比值阳性率（71.4%）高于CMV DNA阳性率（47.6%），差异具有统计学意义（χ^2=4.00, P=0.045）。结论经房水和血清白蛋白校正后的房水CMV IgG抗体校正比值，可有效提高房水CMV IgG抗体检测的特异性，与PCR联合检测，可提高检测的敏感性，该方法有助于提升病毒核酸检测阴性PSS患者的实验诊断水平。

Objective To evaluate the usefulness of albumin correction in determination of cytomegalovirus IgG in the aqueous humor of Posner-Sehlossman syndrome （PSS） patients. Methods Cases series studies. Forty-two patients （26 men and 16 women） who were diagnosed as PSS were enrolled from Oct. 2009 to Oct. 2015 at the Eye and ENT Hospital. During the same period, 20 patients with primary open-angle glaucoma （POAG） and 30 patients with bacterial endophthalmitis or retinal neerosis were enrolled as negative eontrol group and inflammatory disease control group, respectively. Aqueous humor and serum samples were assayed to detect CMV IgC by enzyme-linked immunosorbent assay （ELISA）, and albumin by scattering immunonephelometry. CMV DNA in aqueous humor was assayed by polymerase ehain reaction （PCR）. The ratio which was calculated as the （aqueous humor CMV IgG/serum CMV IgG）/（aqueous humor concentration of albumin/ serum albumin concentration） over 0.6 was considered as intraocular antibody formation. Performance of differentiating control eyes from eyes with CMV-positive PSS was evaluated by the receiver operating characteristic curve. The ANOVA test, Mann-Whitney test and Chi-square test were performed to compare the differences among groups. Results The detectable rate of CMV IgG antibody in the aqueous humor was 76.2%, 100.0% and 10.0% in PSS, inflammatory disease control and POAG groups, respectively. The levels of CMV IgG antibody in the PSS groups were significantly higher than that of POAG groups （Z= 4.23, P〈0.001）.The positive rate corrected by the albumin was 71.4%,3.3% and 0.0%.The corrected positive rate in PSS groups was significantly higher than that of the inflammatory disease control and POAG groups （x^2= 30.38, P〈0.01; x^2= 24.89, P〈0.01）, with a sensitivity of 75.0% and a specificity of 98.0%. The area under the curve for calibrated ratio was 0.942 （95%CI： 0.859 to 0.984） which was higher than that of CMV IgG （Z=6.19, P〈0.001）.The corrected positive rate of CMV IgG antibody （71.4%） was higher than that of CMV DNA （47.6%, x^2=4.003, P=0.045） .Conclusions CMV IgG antibody ratio which was corrected by aqueous humor and serum albumin could effectively improve aqueous antibody specificity in PSS patients. Furthermore, CMV IgG antibody ratio combined with PCR could improve the sensitivity of CMV detection. All of which help clarify the C MV infection in PSS in CMV DNA negative eyes.