超声评分系统在干燥综合征中的诊断价值  

Value of an ultrasonographic scoring system in diagnosis of Sj?gren's syndrome

作　　者：李世文 石娇[2] 华兴[2] 郭燕丽[2] 李景怡[3] 邹庆华[3] 

机构地区：[1]重庆市南岸区人民医院超声科,重庆400060 [2]第三军医大学西南医院超声科,重庆400038 [3]第三军医大学西南医院中西医结合风湿免疫科,重庆400038

出　　处：《第三军医大学学报》2017年第10期996-1000,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81471677)~~

摘　　要：目的评价唾液腺半定量超声评分系统在干燥综合征(Sj?gren’s syndrome,SS)中的诊断价值。方法 2014年6月至2016年6月于西南医院风湿免疫科怀疑为SS的98例患者纳入研究,男性35例,女性63例,年龄35~72岁,平均(52.3±19.8)岁。回顾性分析其腮腺和颌下腺超声检查灰阶与彩色多普勒血流显像声像图表现,将其分为0~4级,获得相应评分,绘制受试者工作特征曲线(receiver operating curve,ROC),计算曲线下面积(area under curve,AUC),评价其诊断价值。对唾液腺超声评分左右侧之间的差异进行比较。对工作经验分别为10年和2年的两名医师评分一致性进行检验。结果 98例患者中53例确诊为SS,45例被排除。唾液腺超声评分所形成ROC曲线AUC为0.892。以2为截断点,唾液腺超声评分法诊断SS的敏感性为94.34%,特异性为88.89%,阳性预测值为90.91%,阴性预测值为93.02%。腮腺和颌下腺超声评分左右侧之间无显著差异性(P>0.05)。不同工作经验的两名医师评分一致性分析Kappa值0.884(P<0.05)。结论唾液腺超声0-4级半定量评分系统对SS具有较高的诊断价值,且观察者一致性好,可用于SS的临床诊断。Objective To evaluate the value of a semi-quantitative ultrasonographic scoring system of the salivary glands in the diagnosis of Sjogren＇ s syndrome （SS）. Methods Ninety-eight patients with a suspected diagnosis of SS in the Southwest Hospital between June 2014 and June 2016 were included in the study. The imaging findings by grey-scale ultrasound and color Doppler ultrasonography of the salivary glands were analyzed and graded according to a 5-point （0 - 4 ） ultrasonographic scoring system. The receiver- operating curve （ROC） was drawn and the area under curve （AUC） was calculated to test the diagnostic performance of this scoring system for SS. The difference in the scores between the bilateral salivary glands was analyzed, and the inter-observer agreement in scoring was tested between two physicians with 10 and 2 years of ultrasound experiences. Results Among the 98 patients, a definite diagnosis of SS was established in 53 patients, and SS was excluded in the other 45 cases. The AUC of the ROC for the uhrasonographic scores of the salivary glands was 0. 892. The sensitivity, specificity, positive predictive value and negative predictive value of this system for SS diagnosis, with the score of 2 as the cut-off point, were 94.34%, 88.89% , 90.91% and 93.02% , respectively. No significant difference was found in the scores between the bilateral salivary glands （P 〉 0. 05 ）, and the Kappa value of the inter-observer agreement was 0. 884 （ P 〈 0.05 ）. Conclusion The semi-quantitative uhrasonobraphic scoring system of the salivary glands has a good diagnostic value for SS with a good inter-observer agreement, and can be used for clinical diagnosis of SS.

关 键 词：干燥综合征 超声 评分系统 诊断 

分 类 号：R181.32[医药卫生—流行病学] R445.1[医药卫生—公共卫生与预防医学]