唾液电解质测定对干燥综合征的诊断价值

Study on the sialochemistry in Sjgren's syndrome and its value in clinical diagnosis

目的通过研究干燥综合征(SS)及其他对照组患者唾液Na+、K+浓度,比值和单位时间总量的变化及相互关系,来寻求一种新的SS鉴别诊断的方法。方法①根据SS、类风湿关节炎(RA)和系统性红斑狼疮(SLE)的诊断标准,将病人分为SS组,RA组,SLE组,单纯性口干组,正常对照组,共5组。②利用混合唾液采取法采集5组唾液标本,应用离子选择电极电位测定分析法测定其唾液Na+、K+浓度,计算出比值和单位时间分泌总量,精密pH试纸测pH值。③分别用t检验和单因素方差分析进行组间比较。结果SS组的唾液Na+浓度和Na+/K+的比值明显高于RA组、SLE组、单纯性口干组及对照组(P<0.001);SS组与RA组、SLE组和对照组比较唾液K+分泌总量显著降低(P<0.01,P<0.001)。由此可见应用敏感性(87.5%)和特异性(91.4%)较高的Na+浓度及特异性(97.9%)高而敏感性(75%)一般的Na+/K+比值来鉴别SS与其他风湿性免疫疾病及单纯性口干具有较高的临床诊断价值。单位时间内K+含量特异性(89.7%)虽然较高,但因敏感性(67.5%)偏低,故可将其用于SS的初步筛选。结论唾液电解质的测定是一种方便、准确、经济的实验方法,有可能成为鉴别诊断SS综合征的指标之一。

Objective To define the reference values of several salivary variables,which had been proved to be potentially relevant to diagnosing Sjgren's syndrome (SS) in a previous study.The sodium,potassium concentration, sodium-potassium ratio and total value per minute of sodium and potassium in patients with SS,other patients and normal controls were studied in order to offer a possible new and non-invasive way of diagnosing SS. Methods ① The subjects were divided according to the European classification criteria for diagnosis of SS and other rheumatic diseases into 5 groups:SS,rheumatoid arthritis,systemic lupus erythematosus,simple xerostomia patients and normal controls.②The concentration of sodium and potassium was examined using lon specific electrode. The total value per minute of sodium and potassium were calculated.PH was measured by pH paper.③ Independent-sample t test and one-way ANOVA were used to determine mean statistical differences among these groups.Results The salivary concentration of sodium and sodium-potassium ratio were significantly elevated (P<0.001) and the total value per minute of potassium was significantly reduced (P<0.01, P<0.001 respectively) in patients with SS, suggesting that combing sodium concentration (high specificity 91.4% and high sensitivity 87.5%) and sodium-potassium ratio (high specificity 97.9% and moderate sensitivity 75%) as salivary variables could be used for diagnosing SS. Although the specificity of the total value per minute of potassium was good (89.7%),it only can be used as an adjunctive diagnostic tool because of its sensitivity was not good enough(67.5%). Conclusion Sjgren's syndrome mainly damages exocrine gland so that the sialochemistry must be changed, which can be used as one of the diagnostic criteria. Because these non-invasive diagnostic tools can be easily applied, and are very accurate, so sialochemistry may be recommended as a diagnostic test for the diagnosing and differentiating Sjgren's syndrome from other rheumatic diseases.