涎腺超声评分联合血清学指标诊断原发性干燥综合征的临床价值

蒋佳纯 许世豪 王晓冰 陈斌

[摘要] 目的 探讨涎腺超声评分法联合血清学指标在原发性干燥综合征（PSS）诊断中的临床意义。 方法 选择2017年6月至2018年6月临床可疑PSS患者101例，根据ACR/EULAR分类标准，将101例患者分为PSS组和非PSS组，通过受试者工作曲线下面积（AUROC），比较单独应用超声评分、血清学指标及两者联合應用诊断PSS的敏感度、特异度等。 结果 单独应用超声评分诊断PSS的AUROC为0.799，敏感度为78.85%，特异度为75.00%;单独应用血清学指标诊断PSS的AUROC为0.813，敏感度为82.69%，特异度为80.00%;两者联合应用诊断PSS的AUROC为0.869，敏感度为76.92%，特异度为92.50%。单独应用血清学指标与超声评分比较，两者对PSS的诊断效能差异无统计学意义（P>0.05）;两者联合应用，与单独应用超声评分或血清学指标比较，联合应用能明显提高诊断效能（P<0.05）。 结论 联合应用超声评分和血清学指标能明显提高PSS的诊断效能，具有较高的临床应用价值。

[关键词] 涎腺;超声评分;原发性干燥综合征;血清学指标

[中图分类号] R593.2          [文献标识码] B          [文章编号] 1673-9701（2021）31-0131-04

[Abstract] Objective To investigate the clinical significance of salivary gland ultrasound scoring combined with serological indicators in the diagnosis of primary Sjgren′s syndrome （PSS）. Methods A total of 101 patients with clinically suspected PSS from June 2017 to June 2018 were assigned to the PSS and non-PSS groups based on ACR/EULAR classification criteria.By means of the area under the receiver operating characteristic（AUROC）， the sensitivity and specificity of the ultrasound scoring and serological indicators used separately and the combined application of the two were compared for the diagnosis of PSS. Results Of ultrasound scoring alone for diagnosis of PSS， the AUROC was 0.799; the sensitivity was 78.85%; the specificity was 75.00%. Of serological indicators alone for diagnosis of PSS， the AUROC was0.813; the sensitivity was 82.69%; the specificity was 80.00%. Of the combined application of ultrasound scoring and serological indicators for diagnosis of PSS， the AUROC was 0.869; the sensitivity was 76.92%; the specificity was 92.50%. No significant difference was observed in the diagnostic efficiency of PSS when using serological indicators and ultrasound scoring alone（P>0.05）， but the combined application of serological indicators and ultrasound scoring alone could significantly improve the diagnostic efficiency of PSS （P<0.05）. Conclusion The combined application of ultrasound scoring and serological indicators can significantly improve the diagnostic efficiency of PSS， which has high clinical application value.

[Key words] Salivary gland; Ultrasound scoring; Primary Sjgren′s syndrome; Serological indicators

原发性干燥综合征（Primary Sjgren's syndrome，PSS）主要累及人体外分泌腺，是一种系统性、自身免疫性疾病，泪腺、涎腺受侵犯后，其分泌功能受到影响，患者常表现为口干、眼干等症状[1-2]。PSS被认为是一种多因素疾病，其潜在的遗传易感性、表观遗传机制和环境因素有助于疾病的发展[3]。PSS早期发病隐匿，症状轻微、多样，易误诊，目前临床上诊断PSS的统一金标准尚未建立。近年来，涎腺超声（Salivary gland ultrasonography，SGU）因其无创、简便、廉价及其高特异性表现，被越来越多地应用于临床。血清学指标抗SSA、抗SSB、抗Ro52是诊断PSS标志性的自身免疫抗体。……