Vissink Arjan, Kalk Wouter W I, Mansour Khaled, Spijkervet Fred K L, Bootsma Hendrika, Roodenburg Jan L N, Kallenberg Cees G M, Nieuw Amerongen Arie V
Department of Oral and Maxillofacial Surgery, University Hospital Groningen, Groningen, The Netherlands.
Arch Otolaryngol Head Neck Surg. 2003 Sep;129(9):966-71. doi: 10.1001/archotol.129.9.966.
To determine the performance of different tear and salivary tests applied in Sjögren's syndrome (SS) and to disclose how these tests relate to common serologic tests in SS.
In addition to the routine ocular and oral tests for diagnosing SS (Schirmer test, rose bengal score, unstimulated whole saliva flow, and parotid sialography), tear breakup time and flow rate of glandular saliva (parotid and submandibular-sublingual [SM/SL]) were evaluated in patients referred for diagnosis of SS. Patients were categorized into primary SS, secondary SS, and non-SS groups according to the revised European classification criteria for SS.
Referral center.
Referred sample of 80 consecutive patients.
Correlation between ocular and salivary measures.
Breakup time performed insufficiently in diagnosing SS, as opposed to the rose bengal score. In patients with primary and secondary SS, a clear correlation was noted between tear and saliva quality and secretion rate, and between the rose bengal score and parotid sialography. Increased rose bengal scores also correlated significantly with hyperglobulinemia and presence of SS-B antibodies in serum, with duration of subjective eye dryness, and with decreased tear-gland function. With regard to the oral tests, whole, parotid, and SM/SL salivary flow decreased significantly with increasing duration of oral complaints, with the stimulated SM/SL flow rate showing the strongest decrease and being more specific in diagnosing SS. Also, parotid sialography was more specific in excluding patients without SS than the commonly applied diagnostic criterion of secretion of unstimulated whole saliva.
The rose bengal score remains the eye test of choice, as it has the highest specificity for SS. Hyperglobulinemia and especially positive serologic findings for SS-B may warrant close monitoring of the eyes, since these serum findings appear to relate to the severity of ocular surface damage. Parotid sialography and stimulated secretion of SM/SL saliva are more specific in diagnosing SS than unstimulated secretion of whole saliva.
确定应用于干燥综合征（SS）的不同泪液和唾液检测的性能，并揭示这些检测与SS中常见血清学检测的关系。
除了用于诊断SS的常规眼部和口腔检测（Schirmer试验、孟加拉玫瑰红评分、非刺激性全唾液流量和腮腺造影）外，还对因SS诊断前来就诊的患者评估了泪膜破裂时间和腺性唾液（腮腺和颌下-舌下腺[SM/SL]）的流速。根据修订后的欧洲SS分类标准，将患者分为原发性SS、继发性SS和非SS组。
转诊中心。
连续80例转诊患者的样本。
眼部和唾液检测指标之间的相关性。
与孟加拉玫瑰红评分相反，泪膜破裂时间在诊断SS方面表现不佳。在原发性和继发性SS患者中，泪液和唾液质量及分泌率之间，以及孟加拉玫瑰红评分与腮腺造影之间存在明显相关性。孟加拉玫瑰红评分升高还与血清中的高球蛋白血症和SS-B抗体的存在、主观眼干持续时间以及泪腺功能下降显著相关。关于口腔检测，随着口腔不适持续时间的增加，全唾液、腮腺唾液和SM/SL唾液流量显著下降，其中刺激性SM/SL流速下降最为明显，且在诊断SS方面更具特异性。此外，腮腺造影在排除非SS患者方面比常用的非刺激性全唾液分泌诊断标准更具特异性。
孟加拉玫瑰红评分仍是首选的眼部检测方法，因为它对SS具有最高的特异性。高球蛋白血症，尤其是SS-B血清学检查结果呈阳性，可能需要密切监测眼部，因为这些血清学检查结果似乎与眼表损伤的严重程度有关。腮腺造影和刺激性SM/SL唾液分泌在诊断SS方面比非刺激性全唾液分泌更具特异性。
