Department of Ophthalmology, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Le Kremlin-Bicêtre Cedex, France.
Invest Ophthalmol Vis Sci. 2011 Jul 15;52(8):5167-73. doi: 10.1167/iovs.10-6671.
To define a combination of the Schirmer I and phenol red thread (PRT) tests that improves the screening of patients with ocular sicca syndrome.
The PRT test was performed before (PRT1) and after (PRT2) the Schirmer I test, in both eyes of 143 patients complaining of ocular dryness secondary to Sjögren's syndrome or sicca asthenia polyalgia syndrome (SAPS; 72 and 71 patients, respectively), and in 40 control patients. Groups were matched by age and sex. After determining the best cutoff values using the receiver operating characteristic procedure, several combinations of PRT and Schirmer I were assessed to improve the predictive values of the procedure.
The best cutoff value for PRT2, estimated at 15 mm, provided a satisfying match between sensitivity and specificity indexes (68% and 90%, respectively), similar to those obtained with the Schirmer I test. If PRT1 alone was ineffective to screen SGS from control patients, the comparison between PRT1 and PRT2 (so-called "DeltaPRT") was found as a good marker to detect patients with persistent tear reflex. Interestingly, the combination of positive Schirmer I, PRT 2, and/or ΔPRT tests was found to be highly predictive of severe ocular sicca syndrome.
The combination of the Schirmer I and PRT tests strongly improves the screening procedure to detect patients with ocular dryness related to Sjögren's syndrome or SAPS. It could be more widely used in daily clinical practice, aside from the Schirmer I test, to optimize the work-up of patients presenting with dry-eye subjective signs.
定义 Schirmer I 和苯酚红线（PRT）试验的组合，以提高对干燥性眼综合征患者的筛查效果。
在 143 例因干燥综合征或干燥性疲劳多肌痛综合征（SAPS；分别为 72 例和 71 例）引起眼干的患者的双眼以及 40 例对照患者的双眼上，先后进行 PRT1 和 Schirmer I 试验。通过受试者工作特征（ROC）曲线确定最佳截断值，然后评估 PRT 和 Schirmer I 的几种组合，以提高该程序的预测值。
PRT2 的最佳截断值为 15mm，此时敏感性和特异性指标（分别为 68%和 90%）之间达到较好的平衡，与 Schirmer I 试验相似。如果 PRT1 不能有效地将 SGS 与对照患者区分开，则 PRT1 和 PRT2 之间的差异（称为“DeltaPRT”）可作为检测持续性泪反射患者的良好标志物。有趣的是，Schirmer I、PRT2 和/或ΔPRT 试验阳性的组合被发现对严重的眼干燥综合征具有高度的预测性。
Schirmer I 和 PRT 试验的组合大大提高了检测与干燥综合征或 SAPS 相关的眼干燥患者的筛查程序。除了 Schirmer I 试验之外，它可以更广泛地应用于日常临床实践中，以优化出现干眼主观症状患者的检查。
