摘要
目的 探讨涎腺超声评分在干燥综合征诊断及疾病活动程度评估中的临床价值.方法 回顾性选取2022年1月至2023年3月在益阳市中心医院门诊或住院的疑似干燥综合征的患者120例,根据唇腺活检的病理分级标准将患者分为阳性组(n=76)和阴性组(n=44).参考2019年OMERACT超声合作组发布的《干燥综合征涎腺超声中病变的定义和分级系统》进行分级判定,计算涎腺超声评分对干燥综合征的诊断效能,比较两组患者的性别构成比、年龄、病程(首发症状至本次住院时间)、临床症状(涎腺肿大、口干、眼干、牙齿脱落、发热、关节痛、乏力、肺间质病变、肾小管酸中毒)、实验室指标(白细胞、血红蛋白、血小板、γ谷氨酰转肽酶、类风湿因子、红细胞沉降率、球蛋白、免疫球蛋白、特异性自身抗体)、疾病活动度,分析唇腺病理分级、涎腺超声评分与临床指标的相关性.结果 涎腺超声评分结果显示,阳性患者76例,阴性44例,诊断符合率为98.33％,敏感度为98.68％,特异度为97.73％.阳性组与阴性组患者在性别构成比、年龄、病程、口干、眼干、牙齿脱落、发热、关节痛、乏力、肺间质病变、肾小管酸中毒、白细胞、血红蛋白、血小板、γ谷氨酰转肽酶、球蛋白、免疫球蛋白和抗干燥综合征抗原A抗体-60KD(SSA-60KD)方面比较,差异均无统计学意义(P＞0.05).阳性组患者的涎腺肿大比率、类风湿因子、红细胞沉降率、免疫球蛋白、抗干燥综合征A抗体-52KD(SSA-52KD)SSA-52KD、EULAR干燥综合征疾病活动指数(ESSDAI)、EULAR干燥综合征患者报告指数(ES-SPRI)均明显高于阴性组,差异均有统计学意义(P＜0.05).涎腺超声评分、唇腺病理分级与ESSDAI、ESSPRI均具有显著相关性(P＜0.05),唇腺病理分级与患者的类风湿因子、红细胞沉降率、SSA-52KD、免疫球蛋白水平以及涎腺肿大具有相关性(P＜0.05),涎腺超声评分同样与患者的类风湿因子、红细胞沉降率、SSA-52KD、免疫球蛋白水平以及涎腺肿大存在相关性,且相关系数优于唇腺病理分级(P＜0.05).结论 涎腺超声评分系统可以作为诊断干燥综合征的临床手段,具有较高的敏感度与特异度,且能够对干燥综合征疾病的活动程度给予一定提示,为临床评估干燥综合征的病变情况提供重要的参考信息.
Abstract
Objective To investigate the clinical value of ultrasonic score of salivary gland in diagnosis of Sjogren's syndrome and evalua-tion of disease activity.Methods A total of 120 patients with Sjogren's syndrome who were hospitalized or out-patient in Yiyang Central Hospital from January 2022 to March 2023 were retrospectively selected and divided into positive group(n=76)and negative group(n=44)according to the pathological grading criteria of labial gland biopsy.According to the Definition and Grading System of Lesions in salivary gland Ultrasound of Sjogren's Syndrome published by OMERACT Ultrasound Collaboration Group in 2019,the grading judgment were made,and the diagnostic efficacy of salivary gland ultrasound score for sjogren's syndrome were calculated.The age,sex composition ratio,disease course(from the first symptom to the duration of hospitalization),clinical symptoms(salivary gland enlargement,dry mouth,dry eyes,joint pain,fatigue,etc.),laboratory indi-cators(leukocytes,hemoglobin,platelets,gamma glutamyltransferase,rheumatoid factors,erythrocyte precipitation rate,globulin,immunoglobu-lin,specific autoantibodies)and disease activity of the two groups were compared The correlation between pathological grade of labial gland,ultra-sonic score of salivary gland and clinical index were analyzed.Results The ultrasonic score of salivary gland showed that 76 patients were positive and 44 were negative.The diagnostic coincidence rate,sensitivity and specificity were 98.33％,98.68％and 97.73％.Gender composition rati-o,age,duration of disease,dry mouth,dry eyes,tooth loss,fever,joint pain,fatigue,pulmonary interstitial disease,renal tubular acidosis,leu-kocytes,hemoglobin,platelets,gamma glutamyl transpeptides,globulin,immunoglobulin and anti-Sjogren's syndrome antigen A antibody-60KD(SSA-60KD)were compared between positive and negative groups.There were no statistical differences(P＞0.05).Rheumatoid fac-tor,erythrocyte sedimentation rate,anti-Sjogren's syndrome A antibody-52KD(SSA-52KD)SSA-52KD,immunoglobulin,EULAR Sjogren's syndrome Disease activity index(ESSDAI),EULAR Sjogren's syndrome Patient Reporting index(ESSPRI)and the proportion of salivary gland swelling were significantly higher in positive group Negative group(P＜0.05).The ultrasonic score of salivary gland and pathological grade of la-bial gland were significantly correlated with ESSDAI and ESSPRI(P＜0.05),and the pathological grade of labial gland were correlated with rheumatoid factor,erythrocyte sedimentation rate,SSA-52KD,immunoglobulin level and salivary gland enlargement(P＜0.05).The ultra-sound score of salivary gland were also correlated with rheumatoid factor,erythrocyte sedimentation rate,SSA-52KD,immunoglobulin level and salivary gland enlargement,and the correlation coefficient were better than that of pathological grade of lip gland(P＜0.05).Conclusion The ultrasonic scoring system of salivary glands can be used as a clinical means for the diagnosis of Sjogren's syndrome,with high sensitivity and speci-ficity,and can give some hints on the degree of activity of sjogren's syndrome,and provide important reference information for the clinical evalua-tion of the lesions of sjogren's syndrome.
维普
万方数据