Department of Radiology and Cancer Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
PLoS One. 2018 Apr 3;13(4):e0195113. doi: 10.1371/journal.pone.0195113. eCollection 2018.
We retrospectively evaluated the effectiveness of combined use of salivary gland ultrasonography (US) and the 2016 American College of Rheumatology/European League Against Rheumatic Disease (ACR/EULAR) classification criteria for improving the diagnostic efficiency in patients with Sjögren's syndrome (SS). A US-based salivary gland disease grading system was developed using a cohort comprising 213 SS or non-SS patients who fulfilled the minimum requirements for classifying SS based on the American-European Consensus Group (AECG) and ACR criteria. Using 62 SS or non-SS patients from the 213 patients and who had also undergone all the 5 examinations needed for the ACR/EULAR classification, we compared the diagnostic accuracy of various combinations of the ACR/EULAR and US classifications for diagnosing SS, using the clinical diagnosis of SS by rheumatologists as the gold standard. The ACR/EULAR criteria discriminated clinical SS patients with 77% and 79% accuracy for those with primary or secondary SS and for those with primary SS, respectively. However, the integrated score system of the ACR/EULAR and US classifications yielded 92% and 93% accuracy for these 2 SS patient groups, respectively, provided that US score of 3 was assigned to patients with US grade ≥2, and then patients with integrated threshold score of ≥5 were diagnosed as SS. Cross-validation also indicated improved accuracy of the integrated ACR/EULAR and US score system (91.9 and 93.0% for primary/secondary and primary SS patients, respectively) over that by the ACR/EULAR criteria alone. (74.2 and 86.0%, respectively). The integrated ACR/EULAR and US scoring system can improve the diagnosis of patients with clinical SS.
我们回顾性评估了联合使用唾液腺超声（US）和 2016 年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）分类标准提高干燥综合征（SS）患者诊断效率的效果。使用基于 US 的唾液腺疾病分级系统，该系统使用了包含 213 例 SS 或非 SS 患者的队列，这些患者根据美国-欧洲共识组（AECG）和 ACR 标准满足了 SS 分类的最低要求。使用来自 213 例患者中的 62 例 SS 或非 SS 患者，这些患者还接受了 ACR/EULAR 分类所需的所有 5 项检查，我们比较了 ACR/EULAR 和 US 分类的各种组合诊断 SS 的准确性，以风湿病学家对 SS 的临床诊断为金标准。ACR/EULAR 标准分别对原发性或继发性 SS 患者和原发性 SS 患者的临床 SS 患者的准确率为 77%和 79%。然而，ACR/EULAR 和 US 分类的综合评分系统分别为这 2 组 SS 患者提供了 92%和 93%的准确率，前提是将 US 评分 3 分配给 US 分级≥2 的患者，然后将综合阈值评分≥5 的患者诊断为 SS。交叉验证还表明，与单独使用 ACR/EULAR 标准相比，综合 ACR/EULAR 和 US 评分系统的准确性得到了提高（原发性/继发性和原发性 SS 患者分别为 91.9%和 93.0%）。 （分别为 74.2%和 86.0%）。综合 ACR/EULAR 和 US 评分系统可改善对有临床 SS 患者的诊断。
