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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (6): 1032-1035. doi: 10.19723/j.issn.1671-167X.2019.06.009

• 论著 • 上一篇    下一篇

超声评分系统在IgG4相关涎腺炎评估中的应用

宁晓然1,2,王子乔1,张珊珊3,张霞1,唐素玫1,刘燕鹰1,△()   

  1. 1. 北京大学人民医院风湿免疫科,北京　100044
    2. 河北省人民医院风湿免疫科,石家庄　050051
    3. 北京大学人民医院超声科,北京　100044
  • 收稿日期:2019-08-26 出版日期:2019-12-18 发布日期:2019-12-19
  • 通讯作者: 刘燕鹰 E-mail:liuyanying20030801@msn.com
  • 基金资助:
    国家重点研发计划(2017YFA0105802);北京大学人民医院研究与发展基金(RDH 2017-02)

Application of ultrasonography scoring system in the assessment of IgG4-related sialadenitis

Xiao-ran NING1,2,Zi-qiao WANG1,Shan-shan ZHANG3,Xia ZHANG1,Su-mei TANG1,Yan-ying LIU1,△()   

  1. 1. Department of Rheumatology & Immunology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Rheumatology & Immunology, People’s Hospital of Hebei Province, Shijiazhuang 050051, China
    3. Department of Ultrasound, Peking University People’s Hospital, Beijing 100044, China
  • Received:2019-08-26 Online:2019-12-18 Published:2019-12-19
  • Contact: Yan-ying LIU E-mail:liuyanying20030801@msn.com
  • Supported by:
    Supported by National Key R&D Program of China(2017YFA0105802);Peking University People’s Hospital Research and Development Funds(RDH 2017-02)

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摘要：

目的 探讨涎腺超声在IgG4相关涎腺炎诊断及鉴别诊断中的临床价值。方法 纳入48例IgG4相关涎腺炎患者及年龄、病程相匹配的50例干燥综合征患者,分别应用评价双侧腮腺和颌下腺超声的16分和48分评分系统评估IgG4相关涎腺炎患者的唾液腺超声改变,及其与干燥综合征患者的区别。分析IgG4相关涎腺炎患者的超声评分与血清学指标之间的相关性。结果 IgG4相关涎腺炎组和干燥综合征组的平均年龄分别为49.23岁和50.44岁。IgG4相关涎腺炎组患者血清IgG4水平均升高,平均(9.60±6.43) g/L,血清IgE中位数为251.5(123.4~543.6) IU/mL。在16分评分系统中,IgG4相关涎腺炎和干燥综合征患者颌下腺超声评分分别为6.0(6.0~8.0)、 4.0(2.0~8.0), 4个腺体评分总和分别为10.0(8.0~14.0)、8.0(4.0~12.0);在48分评分系统中,IgG4相关涎腺炎和干燥综合征患者颌下腺超声评分分别为18.0(14.5~20.0)、11.0(7.0~14.0),4个腺体评分总和分别为26.0(18.5~34.0)、21.5(15.0~26.3);提示在16分和48分评分系统中,IgG4相关涎腺炎的颌下腺评分和4个腺体评分总和均高于干燥综合征组。同时,在48分评分系统中,4个腺体评分总和与血清IgG4水平呈正相关;在16分评分系统中,4个腺体评分总和与血清IgE水平呈正相关。结论 应用半定量评分系统可以评估并客观量化地反映唾液腺病变,同时结合患者的临床表现、血清学指标和/或组织病理学表现,可以辅助IgG4相关涎腺炎的诊断及鉴别诊断,并初步评价疾病的活动度。

关键词: 涎腺炎, 免疫球蛋白G, 干燥综合征, 超声检查, 诊断, 鉴别

Abstract:

Objective: To assess the diagnostic value of salivary gland ultrasonography (SGUS) for IgG4-related sialadenitis.Methods: Ultrasonography examination of major salivary glands was conducted for 48 IgG4-related sialadenitis patients and 50 Sj?gren’s syndrome patients, whose ages and disease duration were matched. The imaging features were graded using two different scoring systems (0-16 and 0-48, respectively) obtained from the grades of bilateral parotid and submandibular glands. The scores were used to further evaluate the features of salivary gland ultrasonography in IgG4-related sialadenitis and to compare them with Sj?gren’s syndrome patients. The association of SGUS scores of IgG4-related sialadenitis group with serological tests was analyzed.Results: The mean age of IgG4-related sialadenitis group and Sj?gren’s syndrome group was 49.23 years and 50.44 years, respectively. The serum IgG4 level of the patients in the IgG4-related sialadenitis group was increased, with an average (9.60±6.43) g/L. And the serum IgE level was at a median of 251.5 (123.4-543.6) IU/mL. In the 0-16 system, the scores of submandibular glands of the patients in IgG4-related sialadenitis and Sj?gren’s syndrome were 6.0 (6.0-8.0) and 4.0 (2.0-8.0), and the scores of the total four glands were 10.0 (8.0-14.0) and 8.0 (4.0-12.0) respectively. In the 0-48 system, the scores of submandibular glands with IgG4-related sialadenitis and Sj?gren’s syndrome were 18.0 (14.5-20.0) and 11.0 (7.0-14.0), and the scores of the total four glands were 26.0 (18.5-34.0) and 21.5 (15.0-26.3) respectively. It suggested that in the 0-16 system and the 0-48 system, scores of submandibular glands and the total of four glands of IgG4-related sialadenitis were higher than those of Sj?gren’s syndrome. Meanwhile, the association analysis of 0-48 system showed a positive correlation of SGUS scores with serum IgG4, which also showed a positive correlation of SGUS scores with serum IgE in 0-16 system.Conclusion: Semi-quantitative ultrasonography scoring systems can evaluate and quantify the lesions of salivary glands, which can be helpful in the diagnosis and differential diagnosis of IgG4-related sialadenitis combined with the clinical manifestations, serological indicators and/or histopathological manifestations. Ultrasonography can also assess the activity of IgG4-related sialadenitis preliminarily.

Key words: Sialadenitis, Immunoglobulin G, Sj?gren’s syndrome, Ultrasonography, Diagnosis, differential

中图分类号: 

  • R781.72

图1

16分系统下IgG4-RS,SS两组的唾液腺超声评分"

图2

48分系统下IgG4-RS组和SS组的唾液腺超声评分"

图3

IgG4-RS患者的超声评分与血清学指标的相关性分析"

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