探讨泪液总免疫球蛋白E(IgE)对过敏性结膜炎(AC)的诊断效能及其与泪液基质金属蛋白酶9(MMP-9)及血清总IgE相关性。

纳入2025年8月1日至12月31日在山西省眼科医院就诊的常年性和季节性AC患者40例(80只眼)和同期纳入健康体检者30例(60只眼)作为研究对象。其中，AC患者40例(80只眼)中男性15例(30只眼)，女性25例(25只眼)；年龄5~59岁，平均年龄35(30.2，44.8)岁。健康对照者30例(60只眼)中男性9例(18只眼)，女性21例(42只眼)；年龄5~59岁，平均年龄35(30.0，49.3)岁。检测两组受试者的泪液总IgE、泪液MMP-9、血清总IgE及血清特异性IgE水平。性别以例数和百分比表示，组间比较采用χ²检验。泪液总IgE、泪液MMP-9、血清总IgE及血清特异性IgE经Kolmogorov-Smirnov检验均不符合正态分布，以中位数和四分位数M(P25, P75)表示，组间比较采用Mann-Whitney U检验。采用Spearman秩相关分析各指标间的相关性，绘制受试者工作特征曲线评估其诊断效能，采用Bootstrap法校正曲线下面积(AUC)的95%置信区间(CI)。

AC患者和对照者的泪液总IgE水平分别为27.53(10.04, 74.30) IU/ml和3.05(0.75, 5.68) IU/ml，差异有统计学意义(U＝1051.0, P <0.05)。AC患者和对照者泪液MMP-9和血清总IgE水平分别为15.56(9.57, 24.58) ng/ml、12.81(5.24, 23.41) ng/ml、94.22(25.22, 221.91) IU/ml及202.95(22.2, 233.67) IU/ml，比较的差异均无统计学意义(U＝693.0, 531.0；P>0.05)。AC患者泪液总IgE与泪液MMP-9及血清总IgE的相关性均无统计学意义(r_s＝0.149, -0.036；P>0.05)。血清总IgE与霉菌组合及葎草均呈正相关其相关性具有统计学意义(r_s＝0.323, 0.379；P<0.05)。霉菌组合与户尘螨或粉尘螨、屋尘、艾蒿或矮豚草及百慕达草或梯牧草均呈正相关其相关性具有统计学意义(r_s＝0.525, 0.435, 0.531, 0.330；P<0.05)。屋尘与葎草呈正相关，其相关性有统计学意义(r_s＝0.383, P<0.05)。经受试者工作特征曲线分析，泪液总IgE诊断AC的AUC为0.878(Bootstrap 95%CI：0.779~0.954)，最佳截断值取5.75 IU/ml时，灵敏度为95.0%，特异度为80.0%，约登指数为0.750，诊断效能较高。血清总IgE诊断AC的AUC为0.441(Bootstrap 95%CI：0.310~0.586)，最佳截断值取23.71 IU/ml时，灵敏度为77.5%，特异度为26.7%，约登指数为0.042，诊断效能较低。

泪液总IgE对AC具有较高的辅助诊断价值，与血清总IgE不相关，可作为眼表局部致敏的核心标志物；与泪液MMP-9不相关，提示二者反映AC不同的病理阶段。血清总IgE与多种吸入性过敏原呈正相关，AC患者存在多致敏倾向。

The aim of this study is to analyze total tear immunoglobulin E (IgE), tear matrix metalloproteinase-9(MMP-9) , and serum total IgE in patients with allergic conjunctivitis (AC), and to investigate their association with AC, diagn ostic value, and potential allergens.

The study included 40 patients (80 eyes) with perennial and seasonal allergic conjunctivitis (AC) who visited the Shanxi Provincial Eye Hospital between August 1 and December 31, 2025, as well as 30 healthy individuals (60 eyes) who underwent routine health examinations during the same period. There were 15 males (30 eyes) and 25 females (25 eyes) in 40 patients (80 eyes) with AC with the average age was 35 (30.2, 44.8) years old (ranging from 5 to 59 years). There were 9 males (18 eyes) and 21 females (42 eyes) in 30 healthy controls (60 eyes) with the average age was 35 (30.0, 49.3) years old (ranging from 5 to 59 years). Levels of total tear IgE, tear MMP-9, total serum IgE, and serum specific IgE were measured and compared between the two groups. Gender were presented as the number of cases and percentage (%). Intergroup comparisons were performed using the chi-square test. Total tear IgE, tear MMP-9, serum total IgE, and serum specific IgE were all found to be non-normally distributed by the Kolmogorov-Smirnov test and were therefore expressed as median and interquartile range M(P25, P75), and were performed using the Mann-Whitney U test between groups. Spearman′s rank correlation analysis was used to assess the correlations among the indicators. Receiver operating characteristic (ROC) curves were plotted to evaluate diagnostic performance, and the 95% confidence intervals for the AUC were corrected using the bootstrap method.

The total IgE levels in tear fluid of AC patients and controls were 27.53 (10.04, 74.30) IU/ml, 3.05 (0.75, 5.68) IU/ml, respectively, with a statistically significant difference (U=1051.0, P<0.05). The tear MMP-9 levels in AC patients and controls were 15.56 (9.57, 24.58) ng/ml and 12.81 (5.24, 23.41) ng/ml, and serum total IgE levels were 94.22 (25.22, 221.91) IU/ml and 202.95 (22.2, 233.67) IU/ml, respectively; the differences were not statistically significant between them (U=693.0, 531.0; P>0.05). Total IgE in tear fluid from AC patients was not correlated with tear fluid MMP-9 or serum total IgE, and the differences were not statistically significant (r_s=0.149, -0.036; P>0.05). Serum total IgE was positively correlated with the fungal panel and mugwort, and the correlations were statistically significant (r_s=0.323, 0.379; P<0.05) . The fungal panel was positively correlated with house dust mites or dust mites, house dust, mugwort or ragweed, and Bermuda grass or ryegrass, all with statistical significance (r_s=0.525, 0.435, 0.531, 0.330; P< 0.05). House dust was positively correlated with mugwort, with statistical significance (r_s=0.383, P<0.05). According to ROC curve analysis, the AUC for diagnosing AC using total IgE in tears was 0.878 (Bootstrap 95%CI: 0.779 to 0.954). When the optimal cutoff value was set at 5.75 IU/mL, the sensitivity was 95.0%, the specificity was 80.0%, and the Youden index was 0.750, indicating high diagnostic performance. The AUC for serum total IgE in diagnosing AC was 0.441 (Bootstrap 95%CI: 0.310 to0.586). When the optimal cutoff value was set at 23.71 IU/mL, the sensitivity was 77.5%, the specificity was 26.7%, and the Youden index was 0.042, indicating low diagnostic performance.

Total IgE in tears has high diagnostic value for AC, which is not correlated with serum total IgE and can serve as a key biomarker for local sensitization of the ocular surface. It is also not correlated with MMP-9 in tears, suggesting that the two reflect different pathological stages of AC. Serum total IgE is positively correlated with various inhalant allergens, indicating a tendency toward multisensitization in patients with AC.