唾液腺超声评分联合剪切波弹性成像在原发性干燥综合征中的诊断价值

Salivary Gland Ultrasonic Scoring Combined with Shear-wave Elastography in the Diagnosis of Primary Sjogren’s Syndrome

目的探讨唾液腺超声评分联合剪切波弹性成像(SWE)在原发性干燥综合征(pSS)诊断中的应用价值。方法前瞻性选取2020年12月至2021年12月于(具体医院)风湿免疫科就诊的有口干、眼干症状的疑似pSS患者106例,依据诊断结果将其分为pSS组(确诊pSS,n=62)和非pSS组(排除pSS,n=44)。对所有患者进行双侧腮腺及双侧颌下腺二维超声检查及SWE检查,并进行超声评分及SWE杨氏模量值测定,通过绘制ROC曲线比较腮腺及颌下腺单独应用超声评分、SWE以及超声评分联合SWE诊断pSS的效能。结果pSS组腮腺及颌下腺超声评分均高于非pSS组(均P<0.001);pSS组的腮腺和颌下腺杨氏模量值均显著高于非pSS组(均P<0.01);腮腺超声评分诊断与SWE诊断的AUC比较差异无统计学意义(P=0.093),联合诊断的AUC显著高于超声评分诊断(P=0.002),SWE诊断与联合诊断的AUC比较差异无统计学意义(P=0.072);颌下腺超声评分诊断的AUC显著高于SWE诊断(P=0.028),超声评分诊断与联合诊断的AUC比较差异无统计学意义(P=0.349),联合诊断的AUC显著高于SWE诊断(P<0.001)。结论超声评分方法对腮腺及颌下腺而言都具有良好的pSS诊断效能,相较于颌下腺,SWE应用于腮腺时对pSS诊断的效能更高,超声评分联合SWE可以提高诊断的特异性。对早期有口干、眼干等疑似pSS的患者进行超声检查时,应首选腮腺检查。

Objective To investigate application value of salivary gland ultrasound scoring combined with shear-wave elastography(SWE)in the diagnosis of primary Sjogren’s syndrome(pSS).Methods 106 patients with suspected pSS with dry eyes and dry mouth,admitted to the First Affiliated Hospital of Nanchang University from December 2020 to December 2021,were prospectively selected.Based on diagnostic results,they were divided into a pSS group(confirmed pSS,n=62)and a non-pSS group(pSS excluded,n=44).All patients underwent bilateral parotid gland and bilateral submandibular gland two-dimensional ultrasonography and SWE examination.Ultrasonic scoring and SWE Young’s modulus value measurement were performed.The efficacy of ultrasound scoring alone,SWE,and ultrasound scoring combined with SWE for the diagnosis of pSS in the parotid and submandibular glands was compared by plotting ROC curves.Results The ultrasound scores of parotid and submandibular glands in the pSS group were higher than those in the non-pSS group(both P<0.001).The Young’s modulus values of parotid and submandibular glands in the pSS group were significantly higher than those in the non-pSS group(both P<0.01).There was no significant difference in AUC between the parotid ultrasound scoring diagnosis and the SWE diagnosis(P=0.093).The AUC of the combined diagnosis was significantly higher than that of the ultrasound scoring diagnosis(P=0.002),while there was no significant difference in AUC between the SWE diagnosis and the combined diagnosis(P=0.072).The AUC of the submandibular gland ultrasound scoring diagnosis was significantly higher than that of the SWE diagnosis(P=0.028).There was no significant difference in AUC between the ultrasound scoring diagnosis and the combined diagnosis(P=0.349),while the AUC of the combined diagnosis was significantly higher than that of the SWE diagnosis(P<0.001).Conclusions The ultrasound scoring method demonstrates positive diagnostic efficacy for pSS in both parotid and submandibular glands.SWE is more valuable for the evaluation of parotid gland involvement than the submandibular gland in pSS patients,and the addition of SWE in the ultrasound scoring can improve the specificity of diagnosis.When performing ultrasound examination on early-stage patients with suspected pSS symptoms such as dry mouth and eyes,priority should be given to parotid gland examination.