摘要
目的探讨不依赖于唇腺活组织病理检查(LSGB)的无创性积分(NIS)分类标准在干燥综合征(SS)的临床应用价值。方法收集76例疑诊SS患者的临床资料,分别使用NIS分类标准、2002年SS国际分类标准(AECG分类标准)进行诊断,并以患者的眼部及口腔症状、体征,自身免疫抗体、LSGB阳性及后续随访结果确定SS的诊断。比较NIS分类标准、AECG分类标准及LSGB对于SS的诊断效能。结果最终诊断SS 42例,排除SS 34例。SS患者与非SS患者的眼部症状、口腔症状、角膜荧光染色、组织病理学、口腔体征、合并免疫性甲状腺疾病阳性率比较差异均有统计学意义(P均<0.05),2组间Schirmer'sⅠ试验、自身抗体阳性率比较差异无统计学意义(P均>0.05)。42例SS患者中,NIS大于4分36例,小于4分1例,等于4分5例(入组患者中,等于4分共16例,其中6例LSGB阳性、10例阴性,阳性的6例中5例最终确定为SS,阴性的10例均非SS)。NIS分类标准诊断SS的敏感度和特异度分别为97.6%和94.1%,阴性预测值和阳性预测值分别为97.0%和95.3%,诊断准确率为96.1%。NIS分类标准诊断SS的ROC曲线下面积为0.959(0.905,1.000),诊断效能优于AECG分类标准及LSGB(P<0.05)。结论 NIS分类标准优于AECG分类标准,具有更高的诊断效能。NIS小于4分及大于4分可分别用于排除及诊断SS,对于4分的患者进一步行LSGB可明确诊断。
Objective To compare the clinical values among non-invasive score（ NIS）,AmericanEuropean Consensus Group＇s classification criteria（ AECG,2002） and labial salivary gland biopsy（ LSGB） in the diagnosis of Sjgren＇s syndrome（ SS）. Methods Clinical data of 76 cases suspected with SS were collected. NIS and AECG classification criteria were utilized for the diagnosis of SS,which was further validated by ocular and oral symptoms,physical signs,autoantibodies,positive LSGB outcomes and subsequent follow-up.The diagnostic values of NIS,AECG and LSGB were statistically compared. Results Among 76 patients suspected with SS,42 were definitely diagnosed with SS. Ocular and oral symptoms,corneal fluorescent staining,histopathological findings,physical signs,positive rate of complicated with autoimmune thyroid disorders significantly differed（ all P〈0. 05）,whereas Schirmer＇s Ⅰ test and autoantibodies did not considerably differ between SS patients and healthy counterparts（ both P〈0. 05）. Among the 42 SS patients,there were 36 patients had NIS score 4,1 with NIS score 4,and 5 with NIS score = 4（ totally 16 with NIS score = 4,6 with positive LSGB and 5 with SS,10 with negative LSGB and none with SS）. The sensitivity and specificity for the NIS classification criteria were 97. 6% and 94. 1% in the diagnosis of SS. The negative and positive predictive values were 97. 0% and 95. 3%,and the diagnostic accuracy was 96. 1%. The area under the ROC curves for NIS classification criteria was 0. 959（ 0. 905-1. 000）,significantly higher compared with those for the AECG classification criteria and LSGB（ both P〈0. 05）. Conclusions NIS classification criterion yields higher accuracy than AECG in the diagnosis of SS. NIS score of 4 acts as the cut-off value for the diagnosis of SS. For patients with NIS score 4,LSGB is recommended to confirm the diagnosis.
出处
《新医学》
2016年第4期237-241,共5页
Journal of New Medicine
基金
广东省科技计划项目(2012B031800375
2012B031800457
2014A020221009)
广东省医学科学基金(B2014116)
关键词
干燥综合征
分类标准
诊断
无创性
积分
Sjgren＇s syndrome
Classification criteria
Diagnosis
Non-invasive
Score
