摘要
目的探讨血清学指标联合常规超声及超声造影评分在原发性干燥综合征(pSS)诊断中的临床价值。方法前瞻性选取2017年6月至2018年12月在温州医科大学附属第一医院就诊的161例可疑pSS患者为研究对象,记录患者基线资料,完善实验室检查、相关的诊断实验及唇腺病理检查。将入组的161例患者分为pSS组83例与非pSS组78例。对所有患者腮腺及颌下腺行涎腺超声检查(SGU)后按0~4分评分系统评分,并进行超声造影(CEUS)检查,获得造影参数。应用Logistic回归分析,对参数进行筛选,构建超声造影评分方程。将血清学指标联合超声总评分、超声造影评分、超声总评分及超声造影评分、唇腺病理分级分别构建4种pSS诊断模型,应用ROC曲线评估4种模型对pSS的诊断效能,应用DeLong统计方法比较ROC曲线下面积(AUC),并计算敏感度、特异度、阳性预测值、阴性预测值及似然比。结果与非pSS组相比,pSS组超声总评分的中位数较高(8 vs 4,P<0.001),pSS组的颌下腺造影参数曲线梯度(Grad)的中位数(1.36 vs 1.94,P<0.001),时间-强度曲线下面积(Area)的中位数(876.49 vs 954.27,P=0.003),腺体峰值强度(PI)的中位数(-51.20 dB vs-49.20 dB,P=0.001),腺体强度差值(ID)的中位数(15.90 dB vs17.80 dB,P=0.003)均较小,pSS组颌下腺造影剂达峰时间(TTP)的中位数大于非pSS组(10.01 s vs 9.10 s,P=0.046)。构建超声造影评分方程为:y=7.760-1.534×颌下腺Grad。4种pSS诊断模型的ROC比较结果显示:血清联合超声总评分诊断pSS的AUC为0.860;血清联合超声造影评分的AUC为0.854;血清联合病理分级的AUC为0.941;血清联合超声造影评分及超声总评分的AUC为0.892。血清联合超声造影评分及超声总评分模型的诊断效能优于血清联合超声总评分模型及血清联合超声造影评分模型,差异存在统计学意义(P=0.024、0.015),而与血清联合病理分级模型相比,两者差异无统计学意义(P=0.066)。结论血清学指标联合常规超声及超声造影评分可以提高对pSS的诊断效能,且与血清学指标联合唇腺病理的诊断效能相当,其在一定程度上可避免过度的有创检查。
Objective To evaluate the clinical value of serological indicators combined with conventional ultrasound and contrast-enhanced ultrasound scoring in the diagnosis of primary Sjögren's syndrome syndrome(pSS).Methods A total of 161 suspected pSS patients who visited the First Affiliated Hospital of Wenzhou Medical University from June 2017 to December 2018 were prospectively selected as the research subjects.Their baseline data were recorded,and relevant laboratory tests,diagnostic tests,and labial gland pathological examinations were performed.The enrolled patients were divided into either a pSS group(83 cases)or a non-pSS group(78 cases).The parotid gland and submaxillary gland of all patients were scored according to a 4-point scoring system after salivary gland ultrasonographic examination,and contrast-enhanced ultrasound examination was performed to obtain contrast parameters.Logistic regression analysis was performed to screen parameters and construct a contrast-enhanced ultrasound contrast scoring equation.Four pSS diagnostic models were constructed by combining serological indicators with total ultrasound score,contrast-enhanced ultrasound score,and labial gland pathological grade.The diagnostic efficacy of the four models for pSS was evaluated by receiver operating characteristic(ROC)curve analysis.The area under the ROC curve(AUROC)of the models was compared by DeLong test,and their sensitivity,specificity,positive predictive value,negative predictive value,and likelihood ratio were calculated.Results Compared with the non-pSS group,the median ultrasound total score was higher(8 vs 4,P<0.001),the median gradient of submandibular gland imaging parameters(Grad)(1.36 vs 1.94,P<0.001),the median area under the time intensity curve(Area)(876.49 vs 954.27,P=0.003),the median peak gland intensity(PI)(-51.20 dB vs-49.20 dB,P=0.001),and the median difference in gland intensity(ID)was smaller(15.90 dB vs 17.80 dB,P=0.003),and the median time to peak(TTP)of submandibular gland contrast agent was greater in the pSS group(10.01 s vs 9.10 s,P=0.046).A scoring equation for contrast-enhanced ultrasound was constructed as follows:y=7.760-1.534×submandibular gland Grad.ROC curve analysis of four pSS diagnostic models showed that the AUROC of serological indicators combined with total ultrasound score for the diagnosis of pSS was 0.860;the AUROC of serological indicators combined with contrast-enhanced ultrasound,score,serological indicators combined with pathological grade,and serological indicators combined with contrast-enhanced ultrasound score and total ultrasound score was 0.854,0.941,and 0.892,respectively.The diagnostic efficacy of serological indicators combined with contrast-enhanced ultrasound score and ultrasound total score was significantly superior to that of serological indicators combined with contrast-enhanced ultrasound score or ultrasound total score(P=0.024 and 0.015,respectively).However,there was no significant difference in diagnostic efficacy between serological indicators combined with pathological grade and serological indicators combined with contrast-enhanced ultrasound score and ultrasound score total score(P=0.066).Conclusion The combination of serological indicators,ultrasound score,and contrast-enhanced ultrasound score can improve the diagnostic efficacy for pSS,and its diagnostic efficacy is comparable to that of serological indicators combined with labial gland pathology.Such diagnostic model can avoid excessive invasive examination to a certain extent.
作者
蒋佳纯
王晓冰
陈培荣
许世豪
Jiang Jiachun;Wang Xiaobing;Chen Peirong;Xu Shihao(Department of Ultrasound Imaging,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Rheumatology and Immunology,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2023年第6期622-630,共9页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
浙江省医药卫生科技计划项目面上项目(2021KY789)。
关键词
涎腺
超声检查
超声造影
原发性干燥综合征
诊断模型
Salivary gland
Ultrasonography
Contrast-enhanced ultrasound
Primary Sj?gren's syndrome
Diagnostic model
