Cornec Divi, Jousse-Joulin Sandrine, Pers Jacques-Olivier, Marhadour Thierry, Cochener Béatrice, Boisramé-Gastrin Sylvie, Nowak Emmanuel, Youinou Pierre, Saraux Alain, Devauchelle-Pensec Valérie
Brest University Medical School Hospital, Brest, France.
Arthritis Rheum. 2013 Jan;65(1):216-25. doi: 10.1002/art.37698.
To determine the accuracy of salivary gland ultrasonography (SGUS) for diagnosing primary Sjögren's syndrome (SS) and to suggest modifications of the American-European Consensus Group (AECG) classification criteria.
We conducted a cross-sectional study in a prospective cohort of patients with suspected primary SS that was established between 2006 and 2011. The echostructure of the bilateral parotid and submandibular glands was graded from 0 to 4, and the gland size was measured; blood flow to the parotid gland was assessed using Doppler waveform analysis. The reference standard was a clinical diagnosis of primary SS as determined by a group of experts blinded to the results of SGUS. Receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic value of the 0-4-point echostructure grade for each of the 4 major salivary glands, the sum of the grades for the 4 glands, and the highest grade among the 4 glands.
Of the 158 patients in the study, 78 had a diagnosis of primary SS according to the experts, including 61 patients (78.2%) who met the AECG criteria. Doppler waveform analysis and gland size measurement showed poor diagnostic performance. The results of ROC curve analysis showed that the highest grade among the 4 glands provided the best diagnostic value. The optimal grade cutoff was 2 (62.8% sensitivity and 95.0% specificity). A weighted score was constructed using scores for the 5 variables selected by logistic regression analysis, as follows: (salivary flow×1.5)+(Schirmer's test×1.5)+(salivary gland biopsy×3)+(SSA/SSB×4.5)+(SGUS×2). According to ROC curve analysis, a score of ≥5 of 12.5 had 85.7% sensitivity and 94.9% specificity, compared with 77.9% sensitivity and 98.7% specificity for the AECG criteria. The addition of SGUS to the AECG criteria increased sensitivity to 87.0% but did not change specificity.
Modifications of the AECG criteria, including the addition of a SGUS score, notably improved diagnostic performance.
确定唾液腺超声检查（SGUS）诊断原发性干燥综合征（SS）的准确性，并建议对欧美共识小组（AECG）分类标准进行修订。
我们对2006年至2011年间建立的疑似原发性SS患者的前瞻性队列进行了横断面研究。对双侧腮腺和颌下腺的回声结构从0至4级进行分级，并测量腺体大小；使用多普勒波形分析评估腮腺的血流情况。参考标准是由对SGUS结果不知情的一组专家确定的原发性SS临床诊断。进行受试者操作特征（ROC）曲线分析，以比较4个主要唾液腺中每个腺体的0 - 4级回声结构分级、4个腺体分级总和以及4个腺体中的最高分级的诊断价值。
研究中的158例患者中，根据专家诊断，78例患有原发性SS，其中61例（78.2%）符合AECG标准。多普勒波形分析和腺体大小测量显示诊断性能较差。ROC曲线分析结果表明，4个腺体中的最高分级提供了最佳诊断价值。最佳分级临界值为2（敏感性62.8%，特异性95.0%）。使用逻辑回归分析选择的5个变量的得分构建加权评分，如下：（唾液流量×1.5）+（施墨试验×1.5）+（唾液腺活检×3）+（抗SSA/抗SSB×4.5）+（SGUS×2）。根据ROC曲线分析，12.5分中≥5分的敏感性为85.7%，特异性为94.9%，而AECG标准的敏感性为77.9%，特异性为98.7%将SGUS添加到AECG标准中可将敏感性提高到87.0%，但特异性未改变。
对AECG标准进行修订，包括增加SGUS评分，显著提高了诊断性能。
