超声评分系统在IgG4相关涎腺炎评估中的应用

Application of ultrasonography scoring system in the assessment of IgG4-related sialadenitis

目的:探讨涎腺超声在IgG4相关涎腺炎诊断及鉴别诊断中的临床价值。方法:纳入48例IgG4相关涎腺炎患者及年龄、病程相匹配的50例干燥综合征患者,分别应用评价双侧腮腺和颌下腺超声的16分和48分评分系统评估IgG4相关涎腺炎患者的唾液腺超声改变,及其与干燥综合征患者的区别。分析IgG4相关涎腺炎患者的超声评分与血清学指标之间的相关性。结果:IgG4相关涎腺炎组和干燥综合征组的平均年龄分别为49.23岁和50.44岁。IgG4相关涎腺炎组患者血清IgG4水平均升高,平均(9.60±6.43)g/L,血清IgE中位数为251.5(123.4~543.6)IU/mL。在16分评分系统中,IgG4相关涎腺炎和干燥综合征患者颌下腺超声评分分别为6.0(6.0~8.0)、4.0(2.0~8.0),4个腺体评分总和分别为10.0(8.0~14.0)、8.0(4.0~12.0);在48分评分系统中,IgG4相关涎腺炎和干燥综合征患者颌下腺超声评分分别为18.0(14.5~20.0)、11.0(7.0~14.0),4个腺体评分总和分别为26.0(18.5~34.0)、21.5(15.0~26.3);提示在16分和48分评分系统中,IgG4相关涎腺炎的颌下腺评分和4个腺体评分总和均高于干燥综合征组。同时,在48分评分系统中,4个腺体评分总和与血清IgG4水平呈正相关;在16分评分系统中,4个腺体评分总和与血清IgE水平呈正相关。结论:应用半定量评分系统可以评估并客观量化地反映唾液腺病变,同时结合患者的临床表现、血清学指标和/或组织病理学表现,可以辅助IgG4相关涎腺炎的诊断及鉴别诊断,并初步评价疾病的活动度。

Objective:To assess the diagnostic value of salivary gland ultrasonography(SGUS)for IgG4-related sialadenitis.Methods:Ultrasonography examination of major salivary glands was conducted for 48 Ig G4-related sialadenitis patients and 50 Sjogren’s syndrome patients,whose ages and disease duration were matched.The imaging features were graded using two different scoring systems(0-16 and0-48,respectively)obtained from the grades of bilateral parotid and submandibular glands.The scores were used to further evaluate the features of salivary gland ultrasonography in IgG4-related sialadenitis and to compare them with Sjogren’s syndrome patients.The association of SGUS scores of IgG4-related sialadenitis group with serological tests was analyzed.Results:The mean age of IgG4-related sialadenitis group and Sjogren’s syndrome group was 49.23 years and 50.44 years,respectively.The serum IgG4level of the patients in the Ig G4-related sialadenitis group was increased,with an average(9.60±6.43)g/L.And the serum IgE level was at a median of 251.5(123.4-543.6)IU/m L.In the 0-16 system,the scores of submandibular glands of the patients in IgG4-related sialadenitis and Sjogren’s syndrome were 6.0(6.0-8.0)and 4.0(2.0-8.0),and the scores of the total four glands were 10.0(8.0-14.0)and 8.0(4.0-12.0)respectively.In the 0-48 system,the scores of submandibular glands with IgG4-related sialadenitis and Sjogren’s syndrome were 18.0(14.5-20.0)and 11.0(7.0-14.0),and the scores of the total four glands were 26.0(18.5-34.0)and 21.5(15.0-26.3)respectively.It suggested that in the 0-16 system and the 0-48 system,scores of submandibular glands and the total of four glands of Ig G4-related sialadenitis were higher than those of Sjogren’s syndrome.Meanwhile,the association analysis of 0-48 system showed a positive correlation of SGUS scores with serum IgG4,which also showed a positive correlation of SGUS scores with serum IgE in 0-16 system.Conclusion:Semi-quantitative ultrasonography scoring systems can evaluate and quantify the lesions of salivary glands,which can be helpful in the diagnosis and differential diagnosis of IgG4-related sialadenitis combined with the clinical manifestations,serological indicators and/or histopathological manifestations.Ultrasonography can also assess the activity of IgG4-related sialadenitis preliminarily.