Serum soluble interleukin-2 receptor level is more sensitive than angiotensin-converting enzyme or lysozyme for diagnosis of sarcoidosis and may be a marker of multiple organ involvement
Serum soluble interleukin-2 receptor level is more sensitive than angiotensin-converting enzyme or lysozyme for diagnosis of sarcoidosis and may be a marker of multiple organ involvement
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DOI：
10.1111/1346-8138.13792
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发表时间：
2017-07-01
影响因子：
3.1
通讯作者：
Okamoto, Hiroyuki
中科院分区：
文献类型：
--
作者：
Thi Hong Nguyen, Chuyen;Kambe, Naotomo;Okamoto, Hiroyuki
结节病的皮肤损害往往是最初的症状，使皮肤科医生是第一个诊断这种肉芽肿病。然而，诊断有时是非常困难的。2015年，日本更新了结节病的诊断标准，血清可溶性白细胞介素2受体（sIL-2 R）升高取代结核菌素反应阴性。因此，我们在皮肤科门诊就诊的患者中评估了sIL-2 R与其他两种常见标志物血管紧张素转换酶（ACE）和溶菌酶的临床效用。72例患者血清sIL-2 R对结节病的诊断敏感性（52.8%）高于ACE（29%）和溶菌酶（26.4%）。此外，sIL-2 R水平在多器官受累和实质浸润患者中显著升高。sIL-2 R水平升高的患者血清ACE和溶菌酶水平较高，肺部受累的发生率较高，胸部X线分期较重，影像学分析显示表达特异性体征的发生率较高。受试者-操作者曲线分析表明，在诊断结节病的阈值临界点，sIL-2 R是一个更好的标志物，与ACE和溶菌酶相比，可用于识别多器官受累患者，检测肺部疾病和实质浸润患者，以及预测特异性体征的存在。此外，sIL-2 R水平的动态变化与临床表现密切相关，而ACE和溶菌酶水平在随访期间变化不大。总之，sIL-2 R可被认为是一个很好的诊断标志物和疾病活动性的潜在指标。
Skin lesions in sarcoidosis are often the initial symptoms that enable the dermatologist to be the first to diagnose this granulomatosis. However, diagnosis is sometimes very problematic. In 2015, the diagnostic criteria for sarcoidosis were updated in Japan, with elevated serum soluble interleukin-2 receptor (sIL-2R) replacing negative tuberculin reaction. Therefore, we assessed the clinical utility of sIL-2R compared with two other common markers, angiotensin-converting enzyme (ACE) and lysozyme, in patients who visited the dermatology clinic. Data from 72 patients showed that sIL-2R was more sensitive than both ACE and lysozyme in supporting a diagnosis of sarcoidosis (52.8%) compared with ACE (29%) and lysozyme (26.4%). Additionally, the sIL-2R level was significantly higher in patients with multiple organ involvement and parenchymal infiltration. Patients with elevated sIL-2R levels had higher serum ACE and lysozyme levels, a higher incidence of pulmonary involvement, more severe chest radiographic stage and a high incidence of expression-specific signs by imaging analysis. Receiver-operator curve analysis showed that sIL-2R was a better marker at the threshold cut-off point compared with ACE and lysozyme for identifying patients with multiple organ involvement, detecting patients with pulmonary disease and parenchymal infiltration as well as predicting the presence of specific signs in the diagnosis of sarcoidosis. Moreover, the kinetics of sIL-2R levels correlated closely with clinical manifestations, in contrast to the modest changes of ACE and lysozyme levels during the follow-up period. In conclusion, sIL-2R may be considered a good marker for diagnosis and a potential indicator of disease activity.