原发性干燥综合征患者临床指标诊断效率的评价  

Evaluation of Diagnostic Efficiency of Clinical Indicators in Patients with Primary Sjogren′s Syndrome

作　　者：陈慧勇[1] 戴晓敏[2] 马莉莉[1] 马晓萍[3] 袁源智[3] 王臻[1] 於强[1] 姜林娣[1] 

机构地区：[1]复旦大学附属中山医院风湿免疫科,上海200032 [2]复旦大学附属中山医院内科,上海200032 [3]复旦大学附属中山医院眼科,上海200032

出　　处：《中国临床医学》2013年第3期407-410,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:评价原发性干燥综合征(primary Sjogren's syndrome,pSS)患者临床指标的诊断效率。方法:选择2011年4月—11月复旦大学附属中山医院收治的43例pSS患者,同时选择因其他原因口干眼干的46例患者为对照组,调查2组患者口眼干燥症状,完善眼科检查(Schirmer试验、双眼泪膜破裂时间及双眼角膜染色)、唇腺活检、血清学指标(血清球蛋白、血沉、C-反应蛋白)、自身抗体[包括抗核抗体(anti-nuclear antibody,ANA)、抗SSA抗体和抗SSB抗体]等检测,计算单个和联合各临床指标诊断的灵敏度、特异度、阳性似然比、阴性似然比。结果:在pSS组,严重口干、严重龋齿、反复腮腺肿大患者的比例以及血清学指标、自身抗体、眼科检查、唇腺活检阳性率均高于对照组(P<0.05)。至少1项眼科检查、ANA、唇腺活检阳性为高灵敏度(>90%);反复腮腺肿大、反复结膜炎、需人工泪液治疗、唇腺活检阳性为高特异度(>90%);联合试验可改善诊断效率。结论:反复腮腺炎、干眼症眼科检查、自身抗体及唇腺活检阳性,有助于pSS诊断。Objective：To evaluate the diagnostic efficiency of clinical indicators in patients with primary Sjogren′s syndrome（pSS）.Methods：From Apr 2011 to Nov 2011,a total of 43 patients with pSS treated in Zhongshan Hospital,Fudan University were enrolled,while 46 patients complaining of dry mouth and dry eyes with other etiology were enrolled as control group.All patients were enquired about the characteristics of dry mouth and dry eyes through questionnaires,and the ophthalmological examinations（Schirmer test,tear film break-up time and cornea dyeing） and lip biopsy were conducted,and the levels of auto-antibodies including anti-nuclear antibody（ANA）,anti-SSA antibody and anti-SSB antibody and serological indicators（serum globulin,blood sedimentation and C-reactive protein） were measured.The sensitivity,specificity,positive likelihood ratio and negative likelihood ratio of a single or all the clinical indicators for diaynosis were calculated.Results： pSS group had more patients with severe dry mouth,severe dental caries,recurrent parotid gland enlargement.Positive ratios of serological indicators,auto-antibodies,ophthalmological examinations and lip biopsy in pSS group were higher than those in control group（P0.05）.Some indicators showed high sensitivity（more than 90 %） in the diagnosis of pSS including at least one positive ophthalmological examination,positive ANA and positive lip biopsy,while others showed high specificity（more than 90 %） including recurrent parotid gland enlargement,conjunctivitis,positive artificial-tear supply,and positive lip biopsy.Joint tests could improve diagnostic efficiency.Conclusions： It is the key point in the diagnosis of pSS that if there are recurrent parotid gland enlargement,positive ophthalmological examinations,positive auto-antibodies,and positive results of lip biopsy.

关 键 词：干燥综合征 诊断 效率 

分 类 号：R442.8[医药卫生—诊断学]