Wernicke Dirk, Hess Heidemarie, Gromnica-Ihle Erika, Krause Andreas, Schmidt Wolfgang A
Clinic for Rheumatology Berlin-Buch, Berlin, Germany.
J Rheumatol. 2008 Feb;35(2):285-93. Epub 2008 Jan 15.
To verify ultrasonographic criteria for examination of the major salivary glands in diagnosis of primary and secondary Sjögren's syndrome (SS).
Three hundred sixteen consecutive patients with rheumatic diseases were selected according to the European Consensus Study Group diagnostic criteria for SS. Fifty-seven had primary SS, 33 had secondary SS, 78 had Sicca symptoms, and 148 patients served as asymptomatic controls. This cohort was analyzed for size and parenchymal echogenicity of the major salivary glands by ultrasonography.
Evident parenchymal inhomogenicity in 2 or more major salivary glands was detected by ultrasonography in patients with primary and secondary SS with a sensitivity of 63.1% and 63.6%, respectively. The specificity of this imaging approach in our cohort was 98.7%. The volume of submandibular glands was reduced in patients with primary and secondary SS by about 30% compared to patients with sicca symptoms and asymptomatic controls. In receiver-operating characteristic (ROC) curve analysis, the detection of reduced volumes of both submandibular glands in patients with primary and secondary SS had a specificity of 93% and a sensitivity of 48% at the cutoff point of 3.0 ml. Of note, the volume of the parotid glands did not differ between the groups of patients. In patients with primary SS, parenchymal inhomogenicity of the salivary glands was strongly associated with positivity for anti-Ro and/or anti-La antibodies.
Ultrasonographic detection of parenchymal inhomogenicity of the major salivary glands and observation of reduced volume of the submandibular glands resulted in high specificities for diagnosis of primary and secondary SS. The data indicate that ultrasonography of major salivary glands is a noninvasive imaging procedure with high diagnostic value for the diagnosis of primary and secondary SS.
验证超声检查主要唾液腺的标准在原发性和继发性干燥综合征（SS）诊断中的应用。
根据欧洲共识研究组的SS诊断标准，选取316例连续的风湿性疾病患者。其中57例为原发性SS，33例为继发性SS，78例有干燥症状，148例患者作为无症状对照。通过超声检查分析该队列中主要唾液腺的大小和实质回声。
超声检查发现原发性和继发性SS患者中2个或更多主要唾液腺存在明显的实质不均匀性，敏感性分别为63.1%和63.6%。在我们的队列中，这种成像方法的特异性为98.7%。与有干燥症状的患者和无症状对照相比，原发性和继发性SS患者的下颌下腺体积减少了约30%。在受试者操作特征（ROC）曲线分析中，原发性和继发性SS患者双侧下颌下腺体积减小的检测在截断点为3.0 ml时，特异性为93%，敏感性为48%。值得注意的是，各患者组之间腮腺体积无差异。在原发性SS患者中，唾液腺实质不均匀性与抗Ro和/或抗La抗体阳性密切相关。
超声检测主要唾液腺实质不均匀性以及观察下颌下腺体积减小对原发性和继发性SS诊断具有高特异性。数据表明，主要唾液腺超声检查是一种对原发性和继发性SS诊断具有高诊断价值的非侵入性成像检查。
