Email Alert | RSS

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)

RICH HTML

   

PDF (PC)

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"

[1] Yamamoto M, Takahashi H, Shinomura Y . Mechanisms and assessment of IgG4-related disease: Lessons for the rheumatologist[J]. Nat Rev Rheumatol, 2013,10(3):148-159.
[2] Vivino FB . Sjögren’s syndrome: Clinical aspects[J]. Clin Immunol, 2017,9(182):48-54.
[3] Umehara H, Okazaki K, Masaki Y , et al. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011[J]. Mod Rheumatol, 2012,22(1):21-30.
[4] Shiboski SC, Shiboski CH, Criswell L , et al. American College of Rheumatology classification criteria for Sjögren’s syndrome: a data-driven, expert consensus approach in the Sjogren’s International Collaborative Clinical Alliance cohort[J]. Arthritis Care Res, 2012,64(4):475-487.
[5] Cornec D, Jousse-Joulin S, Pers JO , et al. Contribution of sali-vary gland ultrasonography to the diagnosis of Sjögren’s syndrome: toward new diagnostic criteria?[J]. Arthritis Rheum, 2013,65(1):216-225.
[6] Hocevar A, Ambrozic A, Rozman B , et al. Ultrasonographic changes of major salivary glands in primary Sjögren’s syndrome. Diagnostic value of a novel scoring system[J]. Rheumatol, 2005,63(3):379-383.
[7] Satomi A, Kenji O, Naoya N , et al. Sonographic appearance of the submandibular glands in patients with immunoglobulin G4-related disease[J]. J Ultrasound Med, 2012,31(3):489-493.
[8] Narayan AK, Baer A, Fradin J . Sonographic findings of IgG4-related disease of the salivary glands: Case report and review of the literature[J]. J Clin Ultrasound, 2018,46(1):73-77.
[9] Omotehara S, Nishida M, Satoh M , et al. Sonographic findings of immunoglobulin G4-related sclerosing sialadenitis[J]. J Med Ultrason, 2016,43(2):257-262.
[10] Li W, Xie XY, Su JZ , et al. Ultrasonographic features of immunoglobulin G4-related sialadenitis[J]. Ultrasound Med Biol, 2016,42(1):167-175.
[11] Shimizu M, Okamura K, Kise Y , et al. Effectiveness of imaging modalities for screening IgG4-related dacryoadenitis and sialadenitis (Mikulicz’s disease) and for differentiating it from Sjögren’s syndrome (SS), with an emphasis on sonography[J]. Arthritis Res Ther, 2015,17(1):223-234.
[12] Zhang X, Zhang S, He J , et al. Ultrasonographic evaluation of major salivary glands in primary Sjögren’s syndrome: comparison of two scoring systems[J]. Rheumatol, 2015,54(9):1680-1687.
[13] Tang J, Cai S, Ye C , et al. Biomarkers in IgG4-related disease: A systematic review [J/OL]. Semin Arthritis Rheum, ( 2019 -06-28). doi: 201910.1016/j.semarthrit.2019.06.018.
[1] 原晋芳, 王新利, 崔蕴璞, 王雪梅. 尿促黄体生成素在女童中枢性性早熟预测中的应用[J]. 北京大学学报（医学版）, 2024, 56(5): 788-793.
[2] 陈心心, 唐哲, 乔艳春, 荣文笙. 北京市密云区4岁儿童患龋状况及其与龋活跃性检测的相关性[J]. 北京大学学报（医学版）, 2024, 56(5): 833-838.
[3] 杨玉淑, 齐晅, 丁萌, 王炜, 郭惠芳, 高丽霞. 抗唾液腺蛋白1抗体联合抗腮腺分泌蛋白抗体对干燥综合征的诊断价值[J]. 北京大学学报（医学版）, 2024, 56(5): 845-852.
[4] 钟华, 李原, 徐丽玲, 白明欣, 苏茵. 18F-FDG PET/CT在风湿免疫病中的应用[J]. 北京大学学报（医学版）, 2024, 56(5): 853-859.
[5] 李正芳,罗采南,武丽君,吴雪,孟新艳,陈晓梅,石亚妹,钟岩. 抗氨基甲酰化蛋白抗体在诊断类风湿关节炎中的应用价值[J]. 北京大学学报（医学版）, 2024, 56(4): 729-734.
[6] 韩艺钧,李常虹,陈秀英,赵金霞. 抗SSB抗体阳性和阴性的原发性干燥综合征患者临床及免疫学特征的比较[J]. 北京大学学报（医学版）, 2023, 55(6): 1000-1006.
[7] 李建斌,吕梦娜,池强,彭一琳,刘鹏程,吴锐. 干燥综合征患者发生重症新型冠状病毒肺炎的早期预测[J]. 北京大学学报（医学版）, 2023, 55(6): 1007-1012.
[8] 孟彦宏,陈怡帆,周培茹. CENP-B抗体阳性的原发性干燥综合征患者的临床和免疫学特征[J]. 北京大学学报（医学版）, 2023, 55(6): 1088-1096.
[9] 吴洁,张雯,梁舒,秦艺璐,范文强. 妊娠期原发性干燥综合征合并视神经脊髓炎谱系疾病危重症1例[J]. 北京大学学报（医学版）, 2023, 55(6): 1118-1124.
[10] 王丽芳,石连杰,宁武,高乃姝,王宽婷. 干燥综合征合并冷凝集素病1例[J]. 北京大学学报（医学版）, 2023, 55(6): 1130-1134.
[11] 姚海红,杨帆,唐素玫,张霞,何菁,贾园. 系统性红斑狼疮及成人Still病合并巨噬细胞活化综合征的临床特点及诊断指标[J]. 北京大学学报（医学版）, 2023, 55(6): 966-974.
[12] 邢海霞,王琳,乔迪,刘畅,潘洁. 干燥综合征口腔疾病的治疗特点[J]. 北京大学学报（医学版）, 2023, 55(5): 929-933.
[13] 傅强,高冠英,徐雁,林卓华,孙由静,崔立刚. 无症状髋关节前上盂唇撕裂超声与磁共振检查的对比研究[J]. 北京大学学报（医学版）, 2023, 55(4): 665-669.
[14] 熊焰,李鑫,梁丽,李东,鄢丽敏,李雪迎,邸吉廷,李挺. 甲状腺粗针穿刺活检病理诊断的准确性评估[J]. 北京大学学报（医学版）, 2023, 55(2): 234-242.
[15] 哈雪梅,姚永正,孙莉华,辛春杨,熊焰. 实性肺胎盘样变形1例及文献复习[J]. 北京大学学报（医学版）, 2023, 55(2): 357-361.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部