结膜角膜染色评分在干燥综合征诊断中的意义  

Diagnostic Significance of Ocular Staining Score in Sj?gren's Syndrome

作　　者：张顺华[1] 卞爱玲[1] 赵岩[2] 张奉春[2] 董怡[2] 

机构地区：[1]中国医学科学院 北京协和医学院 北京协和医院眼科,北京100730 [2]中国医学科学院 北京协和医学院 北京协和医院风湿免疫科,北京100032

出　　处：《中华临床免疫和变态反应杂志》2014年第4期268-272,共5页Chinese Journal of Allergy & Clinical Immunology

基　　金：美国国立卫生研究院干燥综合征国际临床合作联盟(SICCA)项目(N01-DE-32636);国家"十一五"科技支撑计划课题(2008BAI59B03);高等学校博士学科点专项科研基金(20111106120057)

摘　　要：目的了解干燥综合征国际合作联盟(Sjgren’s International Collaborative Clinical Alliance,SICCA)研究提出的结膜角膜染色评分(ocular staining score,OSS)在干燥综合征(Sjgren’s syndrome,SS)诊断中的意义。方法 2004年10月至2008年6月在北京协和医院参加SICCA研究且符合2002年SS国际分类(诊断)标准的患者纳入SS组,与SS组年龄分布和性别分布匹配的正常受检者纳入正常对照组。按照标准化操作程序进行荧光素角膜染色、丽丝胺绿结膜染色、Schirmer I试验和泪膜破碎时间(tear break up time,BUT)等检查。对角膜和结膜染色按照OSS评分标准进行评分。SS组与正常对照组患者均取右眼数据进行分析,绘制SS组和正常对照组OSS、Schirmer I和BUT试验分布频率图,计算不同OSS阳性标准下诊断SS的敏感性和特异性。结果分别以OSS≥3分、OSS≥4分、OSS≥5分、OSS≥6分作为诊断SS的阳性标准,敏感性和特异性分别为78.6%和67.4%、83.9%和66.4%、90.0%和65.0%、95.6%和60.1%。以Schirmer≤5 mm5 min和BUT≤5 s为诊断SS阳性标准时,诊断的敏感性和特异性分别为80.6%和48.5%、77.3%和66.3%。结论以OSS≥5分作为诊断SS的阳性标准,具有较高的诊断敏感性和特异性,诊断意义高于Schirmer试验、BUT。Objective To evaluate the diagnostic significance of ocular staining score （OSS） proposed by Sjogren＇s International Collaborative Clinical Alliance （SICCA） in Sjogren＇s syndrome （SS）.Methods The SS group was composed of SS patients from SICCA study who met the international criteria of SS in 2002 in Peking Union Medical College Hospital （PUMCH） from October 2004 to June 2008.The control group was composed of normal participants who had similar age and gender distribution with the case group.All examinees completed fluorescein cornea staining,lissamine green conjunctiva staining,Schirmer I test and tear break-up time （BUT）.The cornea and conjunctiva staining were graded according to OSS.Data of right eyes in all participants was analyzed.Frequency Histograms of OSS,Schirmer test and BUT were drawn for case group and the control group.Diagnostic Sensitivity and specificity was calculated with different criteria.Results When positive criterions for SS diagnosis were set as OSS≥3,OSS≥4,OSS≥ 5,OSS≥6,the corresponding sensitivity and specificity were 78.6% and 67.4%、83.9% and 66.4%、90.0% and 65.0%、95.6% and 60.1%,respectively.Sensitivity and specificity of Schirmer ≤ 5 mm/5 min and BUT≤5S were 80.6% and 48.5%,77.3% and 66.3%,respectively.Conclsion Criterion of OSS≥5 has the best balance of diagnostic sensitivity and specificity.OSS is superior to the Schirmer test and BUT in the diagnosis of SS.

关 键 词：干燥综合征 干眼病 眼表染色 

分 类 号：R593.2[医药卫生—内科学] R77[医药卫生—临床医学]