颌下腺及腮腺超声检查对原发性干燥综合征的诊断价值

Efficacy of ultrasonography of submandibular gland and parotid gland in primary Sjögren's syndrome

目的探讨颌下腺及腮腺超声检查对原发性干燥综合征(pSS)的诊断价值。方法回顾性研究。选取2017年1月—2020年12月南通大学附属江阴医院确诊pSS患者88例为pSS组,其中男3例、女85例,年龄27~78(53±11)岁。纳入同期有口干或眼干临床表现的非pSS患者49例为对照组,其中男2例、女47例,年龄21~79(55±13)岁。患者均行双侧颌下腺及腮腺超声检查,并据二维灰阶图采用0~4分法进行评分。观察指标:(1)比较2组患者年龄、性别、口眼干燥等临床基线资料;(2)记录2组患者的颌下腺和腮腺超声评分,分别绘制颌下腺、腮腺、颌下腺联合腮腺超声评分诊断pSS的受试者操作特征(ROC)曲线,据约登指数确定超声评分的最佳诊断阈值,以及相应的灵敏度、特异度,比较颌下腺、腮腺、颌下腺联合腮腺超声评分的曲线下面积(AUC);(3)比较pSS组患者双侧颌下腺和腮腺的超声评分,分析颌下腺与腮腺超声评分的相关性。结果(1)88例pSS组及49例对照组患者的年龄、性别及口眼干燥表现差异均无统计学意义(P值均>0.05);(2)ROC曲线显示,颌下腺、腮腺、颌下腺联合腮腺超声评分诊断pSS的约登指数分别为0.669、0.650、0.628,3种方式的最佳诊断阈值均为2分;3种方式诊断pSS的灵敏度分别为95.5%、77.3%、95.5%,特异度分别为71.4%、87.8%、67.3%,AUC[95%可信区间(CI)]分别为0.908(0.856~0.959)、0.845(0.780~0.910)及0.900(0.847~0.953)。其中颌下腺及颌下腺联合腮腺的AUC均高于腮腺,差异均有统计学意义(Z=2.43、2.31,P=0.015、0.021),而颌下腺与颌下腺联合腮腺的AUC差异无统计学意义(Z=1.36,P=0.175)。(3)pSS组患者中,颌下腺超声评分为3(2,3)分,高于腮腺的2(2,3)分(Z=-8.22,P<0.001);颌下腺与腮腺的超声评分呈正相关(rs=0.79,P<0.001)。结论颌下腺及腮腺超声对pSS均具有较高的临床诊断价值,颌下腺超声可能较腮腺更具优势。

Objective This work aims to investigate the diagnostic value of ultrasonography(US)of submandibular and parotid glands with primary Sjögren's syndrome(pSS).Methods A retrospective study was conducted.A total of 88 patients admitted to Jiangyin hospital affiliated to Nantong University Medical College from January 2017 to December 2020 because of pSS were recruited(pSS group).The patients were composed of three males and 85 females,with an average age of 27-78(53±11)years.Then,49 patients without pSS were recruited as the control group at the same period.These patients were composed of two males and 47 females,with an average age of 21-79(55±13)years.All patients with and without pSS were examined by US,the parotid and submandibular salivary glands were examined by US according to a five-point(0-4)ultrasonographic scoring system.(1)Clinical baseline data:age,gender,oral and ocular dryness were compared between the two groups.(2)The ultrasonographic scores of the submandibular and parotid glands of the two groups were analyzed.Receiver-operating characteristic curve(ROC)was used in evaluating the diagnostic value of the ultrasonic scores,The optimal cutoff values of salivary gland ultrasonographic score was determined according to Youden's index.Corresponding sensitivity and specificity were calculated.Difference in performance was analyzed by comparing the areas under the ROC curves(AUC)of the ultrasonographic score reported by DeLong et al.(3)The ultrasonographic scores of the submandibular and parotid glands were compared in the pSS group,and the correlation between the ultrasonographic scores of the submandibular and parotid gland was analyzed.Results(1)No differences in age,gender,oral and ocular dryness were found between two groups(all P values>0.05).(2)The ROC showed that the Youden's index of the ultrasonographic scoring systems of the submandibular and parotid glands and combined scoring systems of the submandibular and parotid glands were 0.669,0.650,and 0.628,respectively.The optimal diagnostic threshold of the three methods was 2 points.The AUC,sensitivity,and specificity of the ultrasonographic scores of the three methods for predicting pSS were 0.908(95%credibility interval[CI]0.856-0.959),95,5%,71.4%,and 0.845(95%CI 0.780-0.910),77.3%,87.8%,and 0.900(95%CI 0.847-0.953),95.5%,67,3%,respectively.The AUC of the submandibular gland and the submandibular gland combined with parotid gland was higher than that of parotid gland,and the differences were statistically significant(Z=2.43,2.31,P=0.015,0.021),while the AUC of the submandibular gland and the submandibular gland combined with parotid gland was not statistically significant(Z=1.36,P=0.175).(3)The ultrasonographic scores of submandibular and parotid glands were 3(2,3)and 2(2,3)of the pSS patients and showed statistically significant differences(Z=-8.22,P<0.001),The ultrasonographic score of the submandibular glands was positively correlated with that of the parotid glands(rs=0.79,P<0.001).Conclusion The US of the submandibular and parotid glands is a useful imaging tool for diagnosing pSS,and the US of the submandibular gland may be more effective than that of the parotid gland in diagnosing pSS.