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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (6): 1123-1127. doi: 10.19723/j.issn.1671-167X.2022.06.011

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Diagnostic performances of salivary gland ultrasonography for Sjögren's syndrome

Yang LIU,Fang CHENG,Yan-ling WANG,Xiang-yan AI,Zhen-hang ZHU,Fu-tao ZHAO*()   

  1. Department of Rheumatology and Immunology, the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201999, China
  • Received:2022-08-12 Online:2022-12-18 Published:2022-12-19
  • Contact: Fu-tao ZHAO E-mail:ftzhao@moisten.org
  • Supported by:
    the Shanghai Pujiang Young Rheumatologists Traning Program(SPROG202005)

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Abstract:

Objective: To evaluate the diagnostic performances of salivary gland ultrasonography(SGUS)in Sj?gren's syndrome(SS). Methods: A total of 246 patients with dry mouth and/or eyes who were treated in the outpatient department and inpatient department of Rheumatology and Immunology Department of the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine from December 2019 to January 2022 were collected. All patients received SGUS examination and scored by 2019 outcome measures in rheumatology clinical trial (OMERACT)ultrasonic scoring system.Their general information, unstimulated saliva flow rate(USFR), Schirmer test and serological test results were recorded. In the study, 193 cases had lip gland biopsy. The 2016 American College of Rheumatology(ACR)/ European League Against Rheumatism(EULAR)classification criteria were adopted as the diagnostic standard of SS. χ2 test was used to compare the difference of salivary gland ultrasonic scores between the two groups. The receiver operating characteristic(ROC) curve was used to evaluate the accuracy of SGUS in diagnosing SS, and the disease characteristics of SGUS positive group and negative group in the SS patients were compared. Results: A total of 175 patients were SS group according to the ACR/EULAR classification, and the remaining 71 patients were non-SS group.There was no significant difference in age [(54.2±11.8) years vs. (53.4±14.9) years, P=0.705] and female (94.4% vs.93.1%, P=1.000) between SS and non-pSS groups. A total of 109 patients were SGUS positive (≥ 2 points), of whom 104 patients met the SS diagnosis and 5 patients did not meet the SS diagnosis. The positive rate of SGUS in SS group was significantly higher than that in non-SS group (59.4% vs. 7.0%, P < 0.001). The accuracy of 2019 OMERACT ultrasonic scoring system to predict ACR/EULAR classification was good, with an area under the curve of 0.762 (95%CI 0.701-0.823). The absolute agreement between the SGUS outcome and ACR-EULAR classification was 69.1%(170/246), with a sensiti-vity of 59.4%(104/175), specificity of 93%(66/71), positive predictive value of 95.4%(104/109) and negative predictive value of 48.2% (66/137). A total of 81 patients were positive SGUS combined with anti-SSA antibody, 100% (81/81) fulfilled the ACR-EULAR criteria, 85 patients were negative SGUS and anti SSA antibody, and 60 patients(70.6%, 60/85) did not fulfil the ACR-EULAR criteria. SGUS positive group had higher antinuclear antibody(ANA) positive rate(83.1% vs. 98.1%, P < 0.001) in the patients with SS. Conclusion: The OMERACT ultrasonic scoring system has high diagnostic value in SS. The combination of SGUS and anti-SSA antibody can improve the diagnostic value.

Key words: Sj?gren's syndrome, Salivary gland, Ultrasound

CLC Number: 

  • R593.2

Table 1

Baseline characteristics of the study population"

Items Non-SS (n=71) SS (n=175) t/χ2/Z P
Age/years, ${\bar x}$±s 54.2±11.8 53.4±14.9 0.860 0.391
Female, n (%) 67 (94.4) 163 (93.1) 0.005 0.946
Course of disease/months，M(P25, P75) 12 (3, 24) 36 (6, 96) -3.332 0.001
Enlargement of salivary gland, n (%) 3 (4.2) 33 (18.9) 8.656 0.003
Schirmer test, n (%) 52 (73.2) 147 (84.0) 3.784 0.052
USFR/(mL/15 min)，${\bar x}$±s 3.8±3.6 1.7±1.4 -5.716 < 0.001
ANA, n (%) 40 (56.3) 161 (92.0) 42.977 < 0.001
Anti-SSA antibody, n (%) 6 (8.5) 127 (72.6) 81.618 < 0.001
Anti-SSB antibody, n (%) 0 (0) 40 (22.9) 19.380 < 0.001
Anti-centrometric antibody, n (%) 5 (7.0) 31 (17.7) 4.605 0.032
RF，n (%) 8 (11.3) 71 (40.6) 19.895 < 0.001
IgG, n (%) 13 (18.3) 97 (55.4) 28.150 < 0.001
ESR/(mm/h), ${\bar x}$±s 17.5±14.2 31.1±21.2 5.039 < 0.001
SGUS, n (%) 5 (7.0) 104 (59.4) 56.172 < 0.001
Lip biopsy (n =193), n (%) 4(6.7) (n=58) 112(83) (n=135) 97.894 < 0.001

Figure 1

Receiver operating characteristic curve of salivary gland ultrasonography scores in diagnosis of Sj?gren's syndrome"

Table 2

Clinical characteristics of SGUS positive and negative groups in patients with SS"

Items SGUS negative (n=71) SGUS positive (n=104) t/χ2/Z P
Age/years, ${\bar x}$±s 53.9±15.1 53.0±14.9 0.396 0.693
Female, n (%) 66 (93.0) 97 (93.3) 0.000 1.000
Course of disease/months，M(P25, P75) 36 (6, 120) 36 (12, 60) -0.087 0.931
Schirmer test, n (%) 58 (81.7) 89 (85.6) 0.474 0.491
ANA, n (%) 59 (83.1) 102 (98.1) 12.862 < 0.001
Anti-SSA antibody, n (%) 46 (64.8) 81 (77.9) 3.635 0.057
Anti-SSB antibody, n (%) 12 (16.9) 28 (26.9) 2.403 0.121
Anti-centrometric antibody, n (%) 9 (12.7) 22 (21.2) 2.081 0.149
RF, n (%) 30 (42.3) 41 (39.7) 0.140 0.708
IgG, n (%) 35 (49.3) 61 (59.6) 1.819 0.177
ESR/(mm/h), ${\bar x}$±s 20.8±18.2 31.2±23.1 -0.118 0.906
USFR/(mL/15 min)，${\bar x}$±s 1.8±1.5 1.7±1.3 0.574 0.567
Lip biopsy, n (%) (n=135) 50/61 (82) (n=61) 62/74 (83.8) (n=74) 0.780 0.780
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