摘要
目的:在我国患者中重新评价原发性干燥综合征(PSS)眼科诊断试验的临床价值。方法:用Schirmer试验、BUT试验和角膜荧光素活体染色试验。在112例PSS患者和185例对照者中,评估上述试验的敏感度和特异度及其主要影响因素。结果:Schirmer、角膜荧光素活体染色和BUT试验的特异度分别为43.8％、93.5％和31.4％,敏感度分别为91.7％、50.0％和87.5％。统计分析显示Schirmer试验和BUT试验的特异度与年龄呈负相关(P<0.001),而敏感度与年龄呈正相关(P<0.05)。在55岁以上的患者,除角膜荧光素活体染色试验外各项试验的诊断价值有限。按目前我国诊断KCS的标准,上述三项试验中两项或两项以上异常,诊断的敏感度和特异度分别为84.8％和49.7％。结论:有持续性眼干患者并Schirmer试验(<5mm/5min)和(或)角膜荧光素活体染色试验阳性可明显提高临床诊断的敏感度(79.5％)和特异度(97.8％)(P<0.001)。
Objective:To revaluate the diagnostic tests for keratoconjunctivitis sicca (KCS) in primary Sjogren' s syndrome in China. Methods: Sensitivities and specificities of traditional tests, corneal rose bengal/fluorescein staining tests and BUT test were e-valuated in 112 primary SS patients and 185 controls. Results: The specificities of Schirmer test, fluorescein staining test and BUT test were 43.8%, 93. 5% and 31.4% , while the sensitivities were 91. 7% , 50.0% and 87. 5% , respectively. Statistical analysis showed that the specificities of both Schirmer test and BUT test were negatively correlated with age, especially above 55 year old (P< 0. 001), while the sensitivities had a positive correlations with age (P<0.05). The sensitivity and specificity of two out of three tests positive were 84. 8% and 49. 7% respectively. The suggestion of adjusting the abnormal value of Schirmer's test to <5mm/5min sounds reasonable as it increases the specificity of the test to 78.15% . Conclusion:Taking the sensation of persisting dryeyes for more than 3 months, together with the positivity of Schirmer' s test and/or corneal staining test as objective criteria, the diagnosis of KCS will be more specific (97.8%) and sensitive (79.5%) than taking two positive out of the above mentioned three tests.
