Contribution of salivary gland ultrasonography to the diagnosis of Sjogren's syndrome: Toward new diagnostic criteria?
Contribution of salivary gland ultrasonography to the diagnosis of Sjogren's syndrome: Toward new diagnostic criteria?
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DOI：
10.1002/art.37698
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发表时间：
2013-01-01
影响因子：
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通讯作者：
Devauchelle-Pensec, Valerie
中科院分区：
文献类型：
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作者：
Cornec, Divi;Jousse-Joulin, Sandrine;Devauchelle-Pensec, Valerie
目的 确定唾液腺超声检查 (SGUS) 诊断原发性干燥综合征 (SS) 的准确性，并建议修改美国欧洲共识组 (AECG) 分类标准。方法我们对2006年至2011年间建立的疑似原发性SS患者的前瞻性队列进行了横断面研究。对双侧腮腺和颌下腺的回声结构进行0至4级分级，并测量腺体大小；使用多普勒波形分析评估腮腺的血流。参考标准是由一组对 SGUS 结果不知情的专家确定的原发性 SS 的临床诊断。采用受试者工作特征（ROC）曲线分析比较4个主要唾液腺各04点回声结构分级、4个腺体分级总和以及4个腺体中最高分级的诊断价值。结果本次研究的158例患者中，经专家诊断，78例诊断为原发性SS，其中符合AECG标准的患者61例（78.2%）。多普勒波形分析和腺体尺寸测量显示诊断性能较差。 ROC曲线分析结果显示，4个腺体中等级最高的诊断价值最佳。最佳分级截止值为 2（敏感性为 62.8%，特异性为 95.0%）。使用逻辑回归分析选择的 5 个变量的分数构建加权分数，如下：（唾液流量 x 1.5）+（Schirmer 测试 x 1.5）+（唾液腺活检 x 3）+（SSA/SSB x 4.5）+（SGUS x 2）。根据ROC曲线分析，评分=5（12.5）的敏感性为85.7%，特异性为94.9%，而AECG标准的敏感性为77.9%，特异性为98.7%。在 AECG 标准中添加 SGUS 将敏感性提高至 87.0%，但没有改变特异性。结论 AECG 标准的修改，包括添加 SGUS 评分，显着提高了诊断性能。
Objective To determine the accuracy of salivary gland ultrasonography (SGUS) for diagnosing primary Sjogren's syndrome (SS) and to suggest modifications of the AmericanEuropean Consensus Group (AECG) classification criteria. Methods We conducted a cross-sectional study in a prospective cohort of patients with suspected primary SS that was established between 2006 and 2011. The echostructure of the bilateral parotid and submandibular glands was graded from 0 to 4, and the gland size was measured; blood flow to the parotid gland was assessed using Doppler waveform analysis. The reference standard was a clinical diagnosis of primary SS as determined by a group of experts blinded to the results of SGUS. Receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic value of the 04-point echostructure grade for each of the 4 major salivary glands, the sum of the grades for the 4 glands, and the highest grade among the 4 glands. Results Of the 158 patients in the study, 78 had a diagnosis of primary SS according to the experts, including 61 patients (78.2%) who met the AECG criteria. Doppler waveform analysis and gland size measurement showed poor diagnostic performance. The results of ROC curve analysis showed that the highest grade among the 4 glands provided the best diagnostic value. The optimal grade cutoff was 2 (62.8% sensitivity and 95.0% specificity). A weighted score was constructed using scores for the 5 variables selected by logistic regression analysis, as follows: (salivary flow x 1.5) + (Schirmer's test x 1.5) + (salivary gland biopsy x 3) + (SSA/SSB x 4.5) + (SGUS x 2). According to ROC curve analysis, a score of =5 of 12.5 had 85.7% sensitivity and 94.9% specificity, compared with 77.9% sensitivity and 98.7% specificity for the AECG criteria. The addition of SGUS to the AECG criteria increased sensitivity to 87.0% but did not change specificity. Conclusion Modifications of the AECG criteria, including the addition of a SGUS score, notably improved diagnostic performance.