干燥综合征54例唾液腺核素显像定量分析与高频超声及唇腺活检对比研究

The Comparative study of salivary gland scintigraphy quantitative analysis and high frequency ultrasound and labial gland biopsy in patients with Sjgren's syndrome

目的:比较唾液腺99mTcO4-放射性核素显像定量分析、高频超声、唇腺活检在干燥综合征诊断中临床价值。方法:对干燥综合征54例患者行常规唾液腺动静态显像,分别于0、5、10、20、40min采集图像利用计算机ROI技术并绘制时间放射性曲线,于40min后行Vitamin C500mg刺激试验,干燥综合征患者按腮腺、颌下腺4个腺体,轻度、中度、重度3级别分别积分,患者的核素总评分(0～12级);根据实质的均匀性分、回声反射高低、高回声面积大小、唾液腺边缘的清晰度分别分为0～3级。从而获得由每个腮腺和颌下腺的得分总和,4个腺体总积分(0～48分);唇腺病理检查结果根据病理变化分为:0、1、2、3、4级。结果:唾液腺放射性核素显像的阳性率为87.8%,特异性81.2%;高频超声的阳性率73.8%,特异性75.6%;唇腺活检阳性率为88.5%,特异性97.2%。高频超声组与核素显像组比较差异有统计学意义(P<0.05),核素显像组与唇腺活检组比较差异无统计学意义(P>0.05)。结论:放射性核素显像检查方法简便无创,具有较高的灵敏度、特异性,为干燥综合征诊断、病情变化及疗效观察提供很好评价手段,有较好的临床应用价值。

Objective：To compare the clinical value of diagnosis in Sjgren＇s syndrome（SS） by salivary gland scintigraphy quantitative analysis,high-frequency ultrasound,and labial gland biopsy.Methods：54 patients with SS patients with conventional static and dynamic imaging of the salivary glands were obtained at 0,5,10,20,40 min ROI image by using computer technology and the mapping of radioactivity time curve;Vitamin C500mg stimulation test was after 40min underwent;according to the parotid,submandibular and glands 4,and mild,moderate,and severe three levels,respectively,in patients with SS radionuclide total scores（0～12 grade） were obtained;in accoradance with the actual uniformity,the brightness level,high-echo area size,and edge definition salivary glands the points were divided into 0-3 levels,so as to gain the score for each parotid and submandibular gland and the sum total score of four glands（0-48 points）;lip adenosis test results were divided,according to pathological changes,into 0,1,2,3 and 4 grades.Results：The salivary gland scintigraphy positive rate was 87.8%,and specificity was 81.2%,The positive rate of high-frequency ultrasound was 73.8%,and specificity was 75.6%.The labial gland biopsy positive rate was 88.5%,and specificity was 97.2%.The high-frequency ultrasound group had significantly lower radionuclide than the imaging group（P0.05）;there was no significant difference（P0.05）,between the radionuclide imaging group and the labial gland biopsy group.Conclusion：High-frequency ultrasound diagnosis in Sjgren＇s syndrome is convenient,but the sensitivity and specificity are poor.Labial biopsy sensitivity and specificity are high,but patients with trauma,is relatively complicated and longer.Radionuclide imaging examination is simple,noninvasive,and with high sensitivity,and specificity;a more objective and accurate assessment of salivary gland function is obtained in normal physiological conditions,and for the diagnosis,the condition changes and efficacy of Sjgren＇s syndrome provides a good evaluation tool,and has good clinical practice.