眼临床体征和诊断测试与干燥性角结膜炎最相容：潜在类别方法。
Ocular Clinical Signs and Diagnostic Tests Most Compatible With Keratoconjunctivitis Sicca: A Latent Class Approach.
机构信息
Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA.
Department of Ophthalmology, University of California San Francisco, San Francisco, California.
出版信息
Cornea. 2020 Aug;39(8):1013-1016. doi: 10.1097/ICO.0000000000002311.
PURPOSE
To evaluate the ocular signs and tests for keratoconjunctivitis sicca (KCS) in the absence of a gold standard.
METHODS
Cross-sectional study of participants from the Sjögren's International Collaborative Clinical Alliance (SICCA) registry. Participants had oral/ocular/rheumatologic examinations, blood/saliva samples collected, and salivary gland biopsy. Latent class analysis (LCA) identified clusters of patients based on 3 to 4 predictor variables relating to signs or tests of KCS. The resulting model-based "gold standard" classification formed the basis for estimated sensitivity and specificity associated with these predictors.
RESULTS
A total of 3514 participants were enrolled into SICCA, with 52.9% classified as SS. LCA revealed a best-fit model with 2 groups. For the gold standard-positive group, an abnormal tear breakup time, ocular staining score (OSS), and Schirmer I had a sensitivity of 99.5%, 91.0%, and 47.4%, respectively. For the gold standard-negative group, an abnormal tear breakup time, OSS, and Schirmer I had a specificity of 32.0%, 84.0%, and 88.5%, respectively. OSS components (fluorescein and lissamine staining), exhibited a sensitivity of 82.6% and 90.5%, respectively, in the gold standard-positive group, whereas these signs in the gold standard-negative group had a specificity of 88.8% and 73.0%, respectively.
CONCLUSIONS
OSS and its components (fluorescein and lissamine staining) differentiated 2 groups from each other better than other KCS parameters and had relatively high sensitivity and specificity.
目的
在缺乏金标准的情况下，评估干燥性角结膜炎（KCS）的眼部体征和检查。
方法
对干燥综合征国际协作临床联盟（SICCA）登记处的参与者进行横断面研究。参与者接受了口腔/眼部/风湿病学检查、血液/唾液样本采集和唾液腺活检。潜在类别分析（LCA）根据与 KCS 的体征或检查相关的 3 到 4 个预测变量，对患者进行聚类。由此产生的基于模型的“金标准”分类为这些预测因子相关的估计敏感性和特异性提供了基础。
结果
共有 3514 名参与者被纳入 SICCA，其中 52.9%被分类为 SS。LCA 显示出最佳拟合模型有 2 个组。对于金标准阳性组，异常泪膜破裂时间、眼染色评分（OSS）和 Schirmer I 的敏感性分别为 99.5%、91.0%和 47.4%。对于金标准阴性组，异常泪膜破裂时间、OSS 和 Schirmer I 的特异性分别为 32.0%、84.0%和 88.5%。OSS 成分（荧光素和丽丝胺染色）在金标准阳性组中的敏感性分别为 82.6%和 90.5%，而在金标准阴性组中的特异性分别为 88.8%和 73.0%。
结论
OSS 及其成分（荧光素和丽丝胺染色）比其他 KCS 参数更好地将两组区分开来，具有相对较高的敏感性和特异性。
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