Álvarez Troncoso Jorge, Giraldo González Luisa F, Coronado Poggio Mónica, Sorriguieta Torre Raquel, Ruiz Bravo-Burguillos Elena, Domínguez Gadea Luis, Soto Abánades Clara
Internal Medicine, Hospital Universitario La Paz, Madrid, ESP.
Nuclear Medicine, Hospital Universitario La Paz, Madrid, ESP.
Cureus. 2024 Jul 24;16(7):e65305. doi: 10.7759/cureus.65305. eCollection 2024 Jul.
Introduction Sicca syndrome, characterized by xerophthalmia and xerostomia, is associated with various autoimmune and non-autoimmune conditions, posing diagnostic challenges. Sjögren's syndrome (SS) is the most prevalent systemic autoimmune disease linked to sicca symptoms. This study evaluates the diagnostic accuracy of salivary gland scintigraphy (SGS) in distinguishing SS from non-Sjögren's sicca conditions, alongside other diagnostic tests. Methods A retrospective analysis was conducted at Hospital Universitario La Paz from December 2019 to March 2023, including 142 patients diagnosed with sicca syndrome. Correlations between qualitative and quantitative SGS data (GE Healthcare, Chicago, Illinois) and multiparametric sicca evaluations were assessed. Results Among the 142 patients, 84 (59.15%) were classified as having SS, with 55 (65.48%) seropositive for anti-Ro antibodies. Abnormal SGS results were found in 135 (95.07%) patients. Qualitative SGS categorized seven (4.93%) as mild, 53 (37.32%) as moderate, 50 (35.21%) as severe, and 21 (14.79%) as functionally annulled. Moderate or worse impairment had a sensitivity of 0.88 and a specificity of 0.17. Functional annulment had a sensitivity of 0.17 and a specificity of 0.97. Quantitative SGS using ejection fraction thresholds of ≤30% and ≤20% had sensitivities of 0.35 and 0.18 and specificities of 0.84 and 0.94, respectively. Quantitative SGS metrics correlated with unstimulated whole salivary flow (WUSF; 0.243; p=0.003) and inversely with lymphocytic infiltration (-0.281; p=0.001). The 2016 American College of Rheumatology/European League Against Rheumatism (ACR-EULAR) classification criteria for Sjögren's syndrome demonstrated an area under the curve (AUC) of 0.932, which improved to 0.951 with the inclusion of SGS parameters. Conclusions SGS is a significant diagnostic tool in the multiparametric evaluation of sicca syndrome, showing strong correlations with histological and immunological markers. Its integration into diagnostic criteria enhances the differentiation between SS and non-Sjögren's sicca conditions, suggesting its potential inclusion in future classification frameworks.
干燥综合征以干眼症和口干症为特征，与多种自身免疫性和非自身免疫性疾病相关，给诊断带来挑战。干燥综合征（SS）是与干燥症状相关的最常见的系统性自身免疫性疾病。本研究评估唾液腺闪烁显像（SGS）在区分干燥综合征与非干燥综合征性干燥状态以及其他诊断测试中的诊断准确性。
于2019年12月至2023年3月在拉巴斯大学医院进行回顾性分析，纳入142例诊断为干燥综合征的患者。评估SGS定性和定量数据（通用电气医疗集团，伊利诺伊州芝加哥）与多参数干燥评估之间的相关性。
142例患者中，84例（59.15%）被归类为患有干燥综合征，其中55例（65.48%）抗Ro抗体血清学阳性。135例（95.07%）患者SGS结果异常。SGS定性将7例（4.93%）归为轻度，53例（37.32%）归为中度，50例（35.21%）归为重度，21例（14.79%）功能丧失。中度或更严重损害的敏感性为0.88，特异性为0.17。功能丧失的敏感性为0.17，特异性为0.97。使用射血分数阈值≤30%和≤20%的定量SGS敏感性分别为0.35和0.18，特异性分别为0.84和0.94。定量SGS指标与未刺激全唾液流（WUSF；0.243；p = 0.003）相关，与淋巴细胞浸润呈负相关（-0.281；p = 0.001）。2016年美国风湿病学会/欧洲抗风湿病联盟（ACR-EULAR）干燥综合征分类标准的曲线下面积（AUC）为0.932，纳入SGS参数后提高到0.951。
SGS是干燥综合征多参数评估中的重要诊断工具，与组织学和免疫学标志物显示出强相关性。将其纳入诊断标准可增强干燥综合征与非干燥综合征性干燥状态之间的鉴别，提示其可能纳入未来的分类框架。
