大唾液腺超声与腮腺和唇腺活检及临床疑似原发性干燥综合征患者分类标准的比较。
Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjögren's syndrome.
机构信息
Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
Ann Rheum Dis. 2017 Nov;76(11):1883-1889. doi: 10.1136/annrheumdis-2017-211250. Epub 2017 Jul 28.
OBJECTIVE
To assess the validity of ultrasound of major salivary glands (sUS) compared with parotid and labial gland biopsies, sialometry, anti-SSA/Ro antibody status and classification criteria in patients clinically suspected with primary Sjögren's syndrome (pSS).
METHODS
103 consecutive outpatients with clinically suspected pSS underwent sUS. Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and clearness of salivary gland border were scored according to the Hocevar scoring system. Total ultrasound score was calculated as the sum of these domains (range 0-48).
RESULTS
Absolute agreement between sUS and parotid (83%) and labial (79%) gland biopsy outcome was good. Negative sUS predicts negative parotid gland biopsy, and positive sUS predicts positive labial gland biopsy. Compared with the American European Consensus Group (AECG) classification, sUS showed an absolute agreement of 82%, sensitivity of 71% and specificity of 92%. Compared with the American College of Rheumatology (ACR) classification, absolute agreement was 86%, sensitivity was 77% and specificity was 92%. Compared with the ACR-European League Against Rheumatism (EULAR) classification, absolute agreement was 80%, sensitivity was 67% and specificity was 94%. Positive sUS predicts classification, but negative sUS does not exclude classification. The combination of positive sUS with presence of anti-SSA/Ro antibodies or negative sUS with absence of anti-SSA/Ro antibodies showed a high predictive value for classification as pSS or non-pSS.
CONCLUSION
In our prospective inception cohort study derived from daily clinical practice, absolute agreement between sUS and salivary gland biopsies was slightly higher for parotid compared with labial gland biopsies. The combination of positive sUS and presence of anti-SSA/Ro antibodies highly predicts classification according to the AECG, ACR and ACR-EULAR classification criteria.
目的
评估大唾液腺超声（sUS）与腮腺和唇腺活检、唾液流率、抗 SSA/Ro 抗体状态和分类标准在临床疑似原发性干燥综合征（pSS）患者中的相关性。
方法
103 例临床疑似 pSS 的连续门诊患者接受了 sUS 检查。根据 Hočevar 评分系统对实质回声、均匀性、低回声区域、高回声反射和腺体边界清晰度进行评分。总超声评分是这些领域的总和（范围 0-48）。
结果
sUS 与腮腺（83%）和唇腺（79%）活检结果的一致性较好。阴性 sUS 预测阴性腮腺活检，阳性 sUS 预测阳性唇腺活检。与美国欧洲共识组（AECG）分类相比，sUS 的一致性为 82%，敏感性为 71%，特异性为 92%。与美国风湿病学会（ACR）分类相比，绝对一致性为 86%，敏感性为 77%，特异性为 92%。与 ACR-欧洲抗风湿病联盟（EULAR）分类相比，绝对一致性为 80%，敏感性为 67%，特异性为 94%。阳性 sUS 可预测分类，但阴性 sUS 不能排除分类。阳性 sUS 伴抗 SSA/Ro 抗体阳性或阴性 sUS 伴抗 SSA/Ro 抗体阴性的组合对分类为 pSS 或非 pSS 具有较高的预测价值。
结论
在我们从日常临床实践中得出的前瞻性队列研究中，sUS 与腮腺活检的一致性略高于唇腺活检。阳性 sUS 与抗 SSA/Ro 抗体阳性的结合高度预测了 AECG、ACR 和 ACR-EULAR 分类标准的分类。
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