Chen Jia-Qi, Zhang Yan, Liao Jia-He, Yang Jian-Ying, Jiang Bo-Han, Huang Zi-Wei, Wu Tzu-Hua, Zhang Li-Ning, Wang Zi-Han, Lei Chun-Xin, Zhang Xi-Ya, Luo Jing, Tao Qing-Wen
Graduate School, Beijing University of Chinese Medicine, Beijing, China.
Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing, China.
Front Med (Lausanne). 2025 May 27;12:1552781. doi: 10.3389/fmed.2025.1552781. eCollection 2025.
Tongue manifestations (tongue fur and tongue body) of traditional Chinese medicine is specific for primary Sjögren's syndrome (pSS). We investigated the value of tongue manifestations in the diagnosis of pSS and established a model for screening or diagnosing pSS.
A total of 400 individuals attended at the China-Japan Friendship Hospital were included in this study. 200 patients with pSS and 200 healthy individuals were randomly divided into training and test sets (7:3 ratio). The training set was used to build models based on combined tongue, tongue fur, and tongue body, respectively, and the optimal model was selected through model discrimination and calibration. The optimal model is internally validated using the bootstrap method and further performed on the test set to assess transportability and generalisability. Receiver operating characteristic curve, calibration curve, Brier score, and decision curve analysis (DCA) were used to evaluate the performance of the model.
In the training set, we identified an optimal model which included sex, age, bluish-purple tongue, thin tongue, fissured tongue, thin fur, and peeling fur, after evaluating and comparing three models. The model demonstrated an area under the curve (AUC) of 0.89, and the lowest Brier score of 0.13, with well-fitted calibration curves. The optimal cut-off value for the model is 0.347, with sensitivity and specificity of 87.86 and 76.43%, respectively. The model also shows well discrimination in internal validation. In the test set, this model demonstrated an AUC of 0.93 and with a Brier score of 0.11, and sensitivity and specificity of 93.33 and 71.67%, respectively. A nomogram for pSS screening was developed based on the model.
The non-invasive, reliable and convenient model, established based on age and sex of the patient and specific tongue manifestations can serve as a clinical reference tool for screening or diagnosing of pSS.
中医舌象表现（舌苔和舌体）在原发性干燥综合征（pSS）中具有特异性。我们研究了舌象表现对pSS诊断的价值，并建立了一种用于筛查或诊断pSS的模型。
本研究纳入了400名在中国-日本友好医院就诊的个体。200例pSS患者和200名健康个体被随机分为训练集和测试集（7:3比例）。训练集分别用于基于舌象、舌苔和舌体建立模型，并通过模型判别和校准选择最优模型。使用自助法对最优模型进行内部验证，并在测试集上进一步评估其可迁移性和通用性。采用受试者工作特征曲线、校准曲线、Brier评分和决策曲线分析（DCA）来评估模型的性能。
在训练集中，通过对三个模型进行评估和比较，我们确定了一个最优模型，该模型包括性别、年龄、青紫舌、瘦薄舌、裂纹舌、薄苔和剥苔。该模型的曲线下面积（AUC）为0.89，最低Brier评分为0.13，校准曲线拟合良好。该模型的最佳截断值为0.347，灵敏度和特异度分别为87.86%和76.43%。该模型在内部验证中也显示出良好的判别能力。在测试集中，该模型的AUC为0.93，Brier评分为0.11，灵敏度和特异度分别为93.33%和71.67%。基于该模型绘制了pSS筛查的列线图。
基于患者年龄、性别和特定舌象表现建立的非侵入性、可靠且便捷的模型，可作为pSS筛查或诊断的临床参考工具。
