原发性干燥综合征的涎腺超声表现及其在诊断中的价值

Salivary glands ultrasound manifestation of primary Sjogren's syndrome and its diagnostic value

目的分析原发性干燥综合征的涎腺超声表现及其在诊断和鉴别诊断中的作用。方法选择2011年5月至2012年4月35例确诊的原发性干燥综合征患者为病例组(22例早期组,13例中晚期组),选择非干燥综合征患者30例为对照组。均进行涎腺超声检查及Schirmer试验、抗SSA/SSB抗体、角膜荧光素染色等实验室检查。观察二维图像特征、涎腺大小、涎腺血流动力学参数,比较涎腺超声检查与三种实验室检查的诊断效能。结果病例组35例中,30例弥漫性改变,5例为局限性改变,腮腺或颌下腺病区低回声数目明显多于对照组。腮腺、颌下腺上下径、左右径和体积呈现早期组>对照组>中晚期组,差异有统计学意义(P均<0.05);早期组腮腺收缩期峰值血流速度(PSV)、颌下腺PSV明显高于对照组(P均<0.05);中晚期组PSV、舒张末期血流速度(EDV)明显低于对照组(P均<0.05)。涎腺超声对原发性干燥综合征诊断的灵敏度(80.00%)、特异度(93.33%)、准确率(86.15%)、阳性预测值(93.33%)、阴性预测值(80.00%)较Schimer试验(71.43%、83.33%、76.92%、83.33%、71.43%)和角膜染色(74.29%、86.67%、80.00%、86.67%、74.29%)均有所提高;而与抗SSA/SSB相当。结论超声可清晰观察涎腺实质回声、腺体大小、血流变化,具有较高的诊断效能,可作为鉴别诊断干燥综合征的首选方法。

Objective To analyzed the salivary glands ultrasound manifestation of primary Sjgren＇s syndrome and its contribution to the diagnosis and differentiation diagnosis. Methods Thirty-five confirmed patients with primary Sjgren＇s syndrome were selected as case group（ early stage group： 22 cases,middle-late stage group： 13 cases）,and 30 patients of nonSjgren＇ s syndrome were selected as the control group. The salivary glands ultrasound,Schirmer test,anti-SSA / SSB antibodies and corneal fluorescent staining were examined in all participants. In the ultrasound examination,the two-dimensional image characteristics,the size and the hemodynamic parameters of salivary glands were observed,and the diagnosis efficacy of ultrasound examination was respectively compared with aforementioned three kinds of laboratory examination. Results In case group,out of 35 patients,30 presented diffuse change,5 presented localized changes,and the low echo numbers in the lesion regions of parotid gland and submaxillary gland were all significantly more than that in control group. The vertical diameter,the horizontal diameter and the volume of both parotid gland and submaxillary gland decreased in the order of early stage group,control group and middle-late stage group（ all P〈0. 05）. The peak systolic velocity（ PSV） of parotid gland and submaxillary gland in early stage group were all significantly higher than that in control group（ all P〈0. 05）; PSV and end-diastolic blood flow velocity（ EDV） in middle-late stage group were all significantly lower than those in control group（ all P〈0. 05）. For the diagnosis of Sjgren＇s syndrome,the sensitivity（ 80. 00%）,specificity（ 93. 33%）,accuracy rate（ 86. 15%）,positive predictive value（ 93. 33%） and negative predictive value（ 80. 00%） in salivary glands ultrasound examination were all improved to some extent compared with Schimer test（ 71. 43%,83. 33%,76. 92%,83. 33%,71. 43%）and corneal fluorescent staining（ 74. 29%,86. 67%,80. 00%,86. 67%,74. 29%） and corresponded to anti-SSA / SSB antibodies. Conclusion The salivary gland ultrasound can be used to clearly observe parenchyma echo,gland size and the changes of blood flow,thereby has a high diagnosis efficacy and can serve as the method of choice for the diagnosis of Sjgren＇s syndrome.