Diagnostic performance of tear function tests in Sjogren's syndrome patients
Diagnostic performance of tear function tests in Sjogren's syndrome patients
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DOI：
10.1038/sj.eye.6702204
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发表时间：
2007-02-01
期刊：
影响因子：
3.9
通讯作者：
Campos, E. C.
中科院分区：
文献类型：
--
作者：
Versura, P.;Frigato, M.;Campos, E. C.
目的：评价原发性干燥综合征（SS-I）诊断标准（Schirmer I、破裂时间、活体染色）的诊断价值，并与眼表状态相关的其他检查进行比较。方法：收集177例患者的临床和细胞学资料，其中SS-1型62例，非ss自身免疫性疾病56例，Sicca综合征59例。泪液检查包括：有效的症状问卷、Schirmer I、Jones试验、Ferning试验、BUT、角膜美感测量、泪液清除试验、丽丝胺绿染色、结膜细胞学检查。对资料进行统计学评价，并计算各试验的敏感性、特异性、似然比（LR+）、受试者-工作特征（ROC）曲线。结果：资料显示Schirmer test I（敏感性0.42，特异性0.76,LR+1.75）和BUT（敏感性0.92，特异性0.17,LR+1.11）的诊断效果较差（ROC分析曲线下面积< 0.58）。经验证的主观症状问卷（灵敏度0.89，特异度0.72,LR+3.18）、Jones试验（灵敏度0.60，特异度0.88,LR+5）、角膜美观测量（灵敏度0.80，特异度0.67,LR+2.42）、泪液清除试验（灵敏度0.63，特异度0.84,LR+3.93）均具有较高的诊断效能（ROC分析曲线下面积均为> 0.70）。丽丝胺绿染色表现最好（灵敏度0.63，特异性0.89,LR+5.72），但结果可能因掺入偏置而失真。结论：我们的数据建议使用有效的问卷调查、琼斯测试、角膜美感测量和泪液清除率评估来实现许多SS-I诊断标准中包含的眼部体征和症状项目。
Objective: To evaluate the diagnostic performance of the tests included in primary Sjogren's syndrome (SS-I) diagnostic criteria (Schirmer I, break-up time, vital dye staining) and to compare them with other examinations related to the ocular surface status.Methods: Clinical and cytological data were collected from 177 patients (62 SS-1, 56 non-SS autoimmune diseases, 59 Sicca syndrome). Tear tests included: a validated questionnaire on symptoms, Schirmer I, Jones test, Ferning test, BUT, corneal aesthesiometry, tear clearance test, lissamine green staining, impression conjunctival cytology. Data were statistically evaluated and sensitivity, specificity, likelihood ratio (LR+), receiver-operating characteristics (ROC) curves were calculated for each test.Results: Data showed a poor diagnostic performance of Schirmer test I (sensitivity 0.42; specificity 0.76; LR+1.75) and BUT (sensitivity 0.92; specificity 0.17; LR+1.11) (area under the curve in ROC analysis < 0.58). Validated subjective symptoms questionnaire (sensitivity 0.89; specificity 0.72; LR+3.18), Jones test (sensitivity 0.60; specificity 0.88; LR+5), corneal aesthesiometry (sensitivity 0.80; specificity 0.67; LR+2.42), and tear clearance test (sensitivity 0.63; specificity 0.84; LR+3.93), all exhibited a high diagnostic performance (area under the curve in the ROC analysis always > 0.70). Lissamine green staining exhibited the best performance (sensitivity 0.63; specificity 0.89; LR+5.72) but the result could be distorted by an incorporation bias.Conclusions: Our data suggest to implement the items for ocular signs and symptoms contained in many SS-I diagnostic criteria with the use of a validated questionnaire, performance of Jones test, corneal aesthesiometry measurement, and tear clearance rate evaluation.