Versura P, Frigato M, Mulé R, Malavolta N, Campos E C
Dept. of Surgical Science and Transplants, Ophthalmology Section, Alma Mater Studiorum Università di Bologna, Italy.
Clin Exp Rheumatol. 2006 Sep-Oct;24(5):567-72.
To verify whether ocular surface tests other than those included in primary Sjögren's syndrome (SS-I) classification criteria (Schirmer I, Break up Time, vital dye staining) may contribute to SS I diagnosis.
Two hundred and sixty-two patients (78 SS-1, 91 non-SS autoimmune diseases, 93 Sicca syndrome) filled a validated questionnaire on symptoms and were evaluated by Schirmer test without (Schirmer I) and with (Jones test) topical anaesthesia, Break Up Time (BUT), corneal aesthesiometry, tear clearance rate, vital dye (lissamine green) staining, impression conjunctival cytology, concentration of tear lysozyme and lactoferrin. Thresholds were selected from Receiver Operating Curves; sensitivity, specificity, likelihood ratio (LR+), predictive values were calculated for each test. A logistic regression model was constructed representing the best diagnostic index for SS.
Data showed a poor diagnostic performance of Schirmer test I (LR+ 1.38) and BUT (LR+ 1.05); results from lissamine green staining may be unreliable due to incorporation bias. Tear lactoferrin (LR+ 4.52), Jones test (LR+ 6.24), tear lysozyme (LR+ 8.0), symptom questionnaire (LR+ 8.62), tear clearance rate (LR+ 18.73) and corneal aesthesiometry (LR+ 20.96) exhibited high diagnostic performance also taken together in the regression model.
Because many of the tests we have screened in this study can be carried out by a trained ophthalmologist in any clinical setting, we recommend that ocular surface impairment is studied with the combination of tests proved to be helpful for the SS I diagnosis.
验证除原发性干燥综合征(SS - I)分类标准中所包含的检查项目(Schirmer I试验、泪膜破裂时间、活体染料染色)之外的眼表检查是否有助于SS - I的诊断。
262例患者(78例SS - 1患者、91例非SS自身免疫性疾病患者、93例干燥综合征患者)填写了一份经过验证的症状问卷,并接受了无表面麻醉(Schirmer I试验)和有表面麻醉(Jones试验)的Schirmer试验、泪膜破裂时间(BUT)、角膜感觉测量、泪液清除率、活体染料(丽丝胺绿)染色、结膜印片细胞学检查、泪液溶菌酶和乳铁蛋白浓度检测。从受试者工作曲线中选择临界值;计算每项检查的敏感性、特异性、阳性似然比(LR +)和预测值。构建一个逻辑回归模型以代表SS的最佳诊断指标。
数据显示Schirmer I试验(LR + 1.38)和BUT(LR + 1.05)的诊断性能较差;由于掺入偏差,丽丝胺绿染色的结果可能不可靠。泪液乳铁蛋白(LR + 4.52)、Jones试验(LR + 6.24)、泪液溶菌酶(LR + 8.0)、症状问卷(LR + 8.62)、泪液清除率(LR + 18.73)和角膜感觉测量(LR + 20.96)在回归模型中综合考虑时也表现出较高的诊断性能。
由于我们在本研究中筛选的许多检查可由经过培训的眼科医生在任何临床环境中进行,我们建议结合经证实有助于SS - I诊断的检查来研究眼表损害情况。