Autotaxin在原发性胆汁性胆管炎和原发性干燥综合征中的意义

Clinical significance of Autotaxin in primary biliary cholangitis and primary Sjogren′s syndrome

目的本研究旨在探究Autotaxin(ATX)在原发性胆汁性胆管炎(PBC)与pSS中的差异与诊断价值。方法取自2020年9月至2021年9月期间237例诊断为PBC、PBC继发SS、pSS以及健康对照组(HC)的血浆,收集各组的临床资料,采用ELISA测定各组ATX的水平,并统计相应灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)和曲线下面积(AUC)等。正态分布数据以±s表示,非正态分布以中位数M(Q1,Q3)表示。应用Mann-Whitney U检验、Spearman秩相关性分析等,评估ATX和各组生化检查之间的差异性和相关性。P<0.05为差异有统计学意义。结果研究结果显示ATX在PBC、PBC继发SS、和pSS阳性率分别为33.9%、33.3%和53.3%;特异度分别为93.1%,100%和93.2%。并且在pSS中的ATX诊断灵敏度和特异度分别为86.5%和93.2%均明显高于PBC组(灵敏度56.8%,特异度93.1%)。与HC组[32.6(21.8,60.5)ng/ml]相比较,ATX水平在PBC[59.3(48.6,86.3)ng/ml,U=1750.50,P<0.001]、PBC继发SS[73.6(53.3,102.4)ng/ml,U=199.00,P<0.001]、pSS[152.6(97.4,192.1)ng/ml,U=264.00,P<0.001]中均有升高,差异有统计学意义。从中位数水平看ATX浓度从pSS组至HC组呈现递减趋势,且ATX在PBC组[AUC(95%CI)=0.73(0.651,0.812),P<0.001],PBC继发SS组[AUC(95%CI)=0.82(0.730,0.912),P<0.001]和pSS组[AUC(95%CI)=0.94(0.898,0.984),P<0.001]中均有一定预测准确性。pSS组中ATX与白蛋白(r=-0.31,P=0.041)含量和ALT(r=-0.26,P=0.024)含量呈负相关性。结论ATX在PBC和pSS中均有诊断价值,且在pSS中的灵敏度和特异度更高。

Objective Primary biliary cholangitis(PBC)and Primary Sjögren′s syndrome(pSS)are autoimmune epithelial inflammatory diseases that share many common clinical symptoms.The aim of this study was to investigate the differences and diagnostic value of Autotaxin(ATX)in PBC and SS.Methods The clinical data of 237 cases diagnosed with PBC,PBC secondary to SS,pSS and healthy individuals(HC)between September 2020 and September 2021 were retrospectively analyzed.The levels of ATX in each group were measured by enzyme-linked immunosorbent assay(ELISA),and the corresponding sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and area under the curve(AUC),etc were analyzed.Normally distributed data were expressed as mean±SD and non-normally distributed as median(IQR).The differences and correlations between ATX and the biochemical tests in each group were assessed by applying the Mann-Whitney U test,Spearman correlation analysis,etc.P<0.05 was considered statistically significant difference.Results The results showed that ATX was positive in 33.9%,33.3%and 53.3%for PBC,PBC secondary SS,and pSS,respectively,with the specificities of 93.1%,100%and 93.2%,respectively.The highest accuracy was achieved in pSS and the sensitivity and specificity were 86.5%and 93.2%,which were higher than those in PBC group(56.8%,93.1%),respectively.Compared with HC[32.6(21.8,60.5)ng/ml],ATX levels in PBC[59.3(48.6,86.3)ng/ml,U=1750.50,P<0.001],PBC-SS[73.6(53.3,102.4)ng/ml;U=199.00,P<0.001],and pSS[152.6(97.4,192.1)ng/ml,U=264.00,P<0.001]were elevated with significant difference(P<0.05).ATX levels showed a decreasing trend from the pSS group to the HC group.ATX in PBC group[AUC(95%CI)=0.73(0.651,0.812),P<0.001],PBC secondary SS group[AUC(95%CI)=0.82(0.730,0.912),P<0.001],and pSS group[AUC(95%CI)=0.94(0.898,0.984),P<0.001]had prediction accuracy.ATX was associated with total protein(r=-0.31,P=0.041)level and glutaminase(r=-0.26,P=0.024)level.Conclusion ATX has diagnostic value in both PBC and SS,and with higher sensitivity and specificity for the latter.