血清淀粉样蛋白A在Vogt-小柳原田综合征早期临床诊断中的价值

目的：探讨血清淀粉样蛋白A（SAA）、C-反应蛋白（CRP）和白细胞计数（WBC）在Vogt-小柳原田（VKH）综合征早期诊断中的价值。方法：选取2016年6月至2018年3月温州医科大学附属眼视光医院就诊的92例VKH综合征患者作为VKH组，另选取78例干眼症患者和95名性别年龄匹配的健康人分别作为干眼症组和健康对照组。分别采用胶体金免疫层析法、免疫荧光干式定量法检测3组SAA、CRP水平，WBC检测采用Sysmex XT-1800i全自动血液分析仪。采用Kruskal-Wallis检验，ROC曲线分析诊断效能。结果：VKH组分别与干眼症组、健康对照组比较，SAA、CRP及WBC水平均明显升高（P＜0.05）；干眼症组与健康对照组比较，差异无统计学意义（P＞0.05）。VKH组患者SAA与CRP和WBC均具有正相关关系（均P＜0.05）。VKH组患者治疗后SAA和WBC的水平显著低于治疗前（均P＜0.05）；而CRP的水平在治疗前后差异无统计表学意义（P＞0.05）。根据ROC曲线分析，SAA、CRP、WBC及联合检测诊断VKH综合征的AUC分别为0.905、0.565、0.888、0.952，最佳临界值分别为3.31 mg/L、5.55 mg/L、8.175×109/L。联合检测取Youden指数最大值所对应的最佳临界值为0.667，其灵敏度为78.26%，特异度为97.89%。结论：SAA联合CRP及WBC有助于提高VKH综合征的诊断效能。SAA可为VKH综合征的辅助诊断提供有用的参考信息。

The value of serum amyloid A in the early clinical diagnosis of Vogt-Koyanagi-Harada syndrome

Objective: To investigate the clinical value of serum amyloid A(SAA), c-reactive protein (CRP) and white blood cell count (WBC) in early diagnosis of Vogt-Koyanagi-Harada syndrome. Methods: Ninety-two patients with Vogt-Koyanagi-Harada syndrome admitted to the Eye Hospital of Wenzhou Medical University from June 2016 to March 2018 were selected as the study subjects; 78 patients with dry eye disease were selected as the eye disease control group and 95 normal people with gender and age matching as the normal control group. SAA and CRP levels of the three groups were detected by colloidal gold immunochromatography and immunofluorescence dry quantitative method respectively; WBC was detected by Sysmex XT-1800i automatic blood analyzer. Variables were compared using Kruskal-wallis test and diagnostic value was measured by using ROC curve. Results: SAA, CRP and WBC levels were significantly increased in the Vogt-Koyanagi-Harada syndrome patients group compared with the dry eye group and the control group, respectively, with statistical difference (P<0.05). Compared with the control group, the differences were not statistically significant in the dry eye group (P>0.05). SAA had positive correlation with CRP and WBC in Vogt-Koyanagi-Harada syndrome patients (all P<0.05). The levels of SAA and WBC were significantly lower after treatment than before treatment (all P<0.05), the levels of CRP were not significantly different before and after the treatment (P>0.05). According to ROC curve analysis, the auC of SAA, CRP, WBC and combined detection for diagnosis of Vogt-Koyanagi-Harada syndrome were 0.905, 0.565, 0.888 and 0.952, respectively. The optimal cut-off values were 3.31 mg/L, 5.55 mg/L, and 8.175×109/L, respectively. The optimal cut-off value corresponding to the maximum value of Youden indexwas 0.667 by combined detection, with the sensitivity being 78.26% and the specificity 97.89%. Conclusion: SAA combined with CRP and WBC could improve the diagnostic efficacy of Vogt-Koyanagi-Harada syndrome. SAA can provide useful reference for the auxiliary diagnosis of Vogt-Koyanagi-Harada syndrome, which is worthy of wide clinical application.