血清淀粉样蛋白A、高迁移率族蛋白1、CD64指数在白内障患者术后眼内炎诊断中的应用

Role of serum amyloid A,high mobility group protein 1 and CD64 index in the diagnosis of endophthalmitis after cataract surgery

目的探讨血清淀粉样蛋白A(serum amyloid A protein,SAA)、高迁移率族蛋白1(high-mobility group box 1,HMGB1)、CD64指数与白内障术后眼内炎患者炎症因子间的相关性。方法选择我院2015年1月至2019年11月白内障术后并发眼内炎患者为感染组(48例48眼),未发生眼内炎患者为对照组(50例50眼)。绘制ROC曲线,分析两组患者血清SAA、HMGB1、CD64指数及白细胞介素1-β(IL-1β)、肿瘤坏死因子-α(TNF-α)及白细胞介素-17(IL-17)在诊断眼内炎中的价值。结果感染组患者血清IL-1β、IL-17、TNF-α、SAA、HMGB1及CD64指数均显著高于对照组(均为P<0.05)。感染组中出现前房积脓患者血清SAA、HMGB1及CD64指数均显著高于未出现前房积脓者(均为P<0.05)。感染组患者血清SAA与其IL-1β及TNF-α,HMGB1与TNF-α,CD64指数与IL-1β、IL-17、TNF-α均呈明显正相关(均为P<0.05)。ROC曲线分析结果显示,血清IL-1β、IL-17及TNF-α在诊断白内障术后眼内炎中的效能均不高(均为AUC<0.750);血清SAA、HMGB1及CD64指数在诊断白内障术后眼内炎中均有较高效能(均为AUC>0.750);各指标单独应用时,以CD64指数诊断效能最高AUC=0.859,95%CI(0.756~0.963),灵敏度及特异度分别为86.4%和57.7%;SAA、HMGB1及CD64指数联合应用能有效提高各指标单独应用效果,其诊断效能最高AUC=0.948,95%CI(0.892~1.000),灵敏度及特异度分别为90.9%和88.5%。结论血清SAA、HMGB1及CD64指数在诊断白内障术后眼内炎、反映眼内炎严重程度中具有一定的价值,有望成为临床预测眼内炎的新型指标。

Objective To investigate the correlation between serum amyloid A(SAA),high mobility group box 1(HMGB1),CD64 index and inflammatory factors in patients with endophthalmitis after cataract surgery.Methods Patients with endophthalmitis after cataract surgery in our hospital from January 2015 to November 2019 were selected as the infection group(48 patients,48 eyes),and patients without endophthalmitis were selected as control group(50 patients,50 eyes).The value of SAA,HMGB1,CD64 index,interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and interleukin-17(IL-17)in the diagnosis of endophthalmitis was analyzed by drawing ROC curve.Results The serum levels of IL-1β,IL-17,TNF-α,SAA,HMGB1 and CD64 in the infection group were significantly higher than those in the control group(all P<0.05).The serum SAA,HMGB1 and CD64 index of patients with hypopyon were significantly higher than those without hypopyon(all P<0.05).In the infection group,SAA was positively correlated with IL-1βand TNF-α,HMGB1 was positively correlated with TNF-α,and CD64 index was positively correlated with IL-1β,IL-17 and TNF-α(all P<0.05).ROC curve analysis showed that serum IL-1β,IL-17 and TNF-αwere not effective in the diagnosis of endophthalmitis after cataract surgery(AUC<0.750).The index of serum SAA,HMGB1 and CD64 had high diagnostic efficiency in the diagnosis of endophthalmitis after cataract surgery(AUC>0.750),and CD64 index had the highest diagnostic efficiency when used alone AUC=0.859,95%CI(0.756-0.963);the sensitivity and specificity were 86.4%and 57.7%,respectively.The combination of SAA,HMGB1 and CD64 index could effectively improve the effect of each index used alone,and the diagnostic efficiency was the highest AUC=0.948,95%CI(0.892-1.000).The sensitivity and specificity were 90.9%and 88.5%,respectively.Conclusion The index of serum SAA,HMGB1 and CD64 have certain value in diagnosing endophthalmitis after cataract surgery and reflecting the severity of endophthalmitis,which is expected to become a new index for clinical prediction of endophthalmitis.