唾液腺超声可用于诊断干燥综合征

摘要: 目的：研究唾液腺超声检查(SGUS)用于诊断原发性干燥综合征(SS)的精确度，并对美欧共识小组(AECG)分类标准提出针对性修改意见。

方法：本文是一项横断面研究，研究对象为2006年到2011年期间参与一项前瞻性队列研究的可疑原发性SS患者。我们对患者的双侧腮腺和颌下腺的回声结构进行了分级(0~4级)，并测定了腺体大小；另外，还利用多普勒波形分析对腮腺血流进行了分析。以由对SGUS结果不知情的专家完成的临床诊断作为参考标准。使用受试者工作特征曲线(ROC)评估不同评分方法的诊断能力，包括1) 分别评分4个大唾液腺，2) 4个唾液腺的总分，3) 4个唾液腺中的最高分。（注：唾液腺超声评级标准：0级：正常。1级：可见低回声纤维结构。2级：可见多个小于2 mm的低回声区，以及高回声条带。3级：可见多个2–6 mm的低回声区，以及高回声条带。4级：可见多个大于6 mm的低回声区。）

结果：本研究共纳入158名患者，其中78名患者根据专家意见被诊断患有原发性SS (其中78.2%，即61名符合AECG诊断标准)(表4)。结果显示，多普勒波形分析及腺体大小测定的诊断价值很低。ROC曲线分析结果显示4个唾液腺中的最高分诊断价值最高，最佳截断值为2(灵敏度为62.8%，特异度为95.0%)。对logistic回归筛选出来的5个变量进行了总加权评分，加权评分方程如下：(唾液腺血流×1.5) + (Schirmer试验×1.5) + (唾液腺活检×3) + (SSA/SSB×4.5) + (SGUS×2)，最高得分为12.5。根据ROC曲线分析结果，如以患者评分≥5为截断值，则可获得的灵敏度为85.7%，特异度为94.9%；而使用AECG标准的灵敏度和特异度分别为77.9%和98.7%。在AECG标准中增加SGUS，则灵敏度可上升至87.0%，但特异度保持不变。

结论：对AECG标准的修改，尤其是加入SGUS评分，可显著提高其诊断能力。

附原文 Objective. To determine the accuracy of salivary gland ultrasonography (SGUS) for diagnosing primary Sjo¨gren’s syndrome (SS) and to suggest modifications of the American–European Consensus Group (AECG) classification criteria. Methods. We conducted a cross-sectional study in a prospective cohort of patients with suspected primary SS that was established between 2006 and 2011. The echostructure of the bilateral parotid and submandibular glands was graded from 0 to 4, and the gland size was measured; blood flow to the parotid gland was assessed using Doppler waveform. analysis. The reference standard was a clinical diagnosis of primary SS as determined by a group of experts blinded to the results of SGUS. Receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic value of the 0–4-point echostructure grade for each of the 4 major salivary glands, the sum of the grades for the 4 glands, and the highest grade among the 4 glands.Results. Of the 158 patients in the study, 78 had a diagnosis of primary SS according to the experts, including 61 patients (78.2%) who met the AECG criteria. Doppler waveform. analysis and gland size measurement showed poor diagnostic performance. The results of ROC curve analysis showed that the highest grade among the 4 glands provided the best diagnostic value. The optimal grade cutoff was 2 (62.8% sensitivity and 95.0% specificity). A weighted score was constructed using scores for the 5 variables selected by logistic regression analysis, as follows: (salivary flow _ 1.5) _ (Schirmer’s test _ 1.5) _ (salivary gland biopsy _ 3) _ (SSA/SSB _ 4.5) _ (SGUS _ 2). According to ROC curve analysis, a score of >5 of 12.5 had 85.7% sensitivity and 94.9% specificity, compared with 77.9% sensitivity and 98.7% specificity for the AECG criteria. The addition of SGUS to the AECG criteria increased sensitivity to 87.0% but did not change specificity.Conclusion. Modifications of the AECG criteria, including the addition of a SGUS score, notably improved diagnostic performance.

引自: Cornec D, Jousse-Joulin S, Pers JO, et al. Contribution of salivary gland ultrasonography to the diagnosis of Sj?gren's syndrome: toward new diagnostic criteria? Arthritis Rheum. 2013; 65(1): 216-225.