【作者】 王旭；

【导师】 高丽霞；

【作者基本信息】 河北医科大学 ， 内科学（专业学位）， 2022， 硕士

【摘要】 目的:探讨涎腺超声(salivary gland ultrasonography,SGUS)在原发性干燥综合征(primary Sj(?)gren’s Syndrome,p SS)中的诊断价值,以及SGUS与p SS患者临床和实验室特征之间的关系,以期为涎腺超声在p SS的诊断和病情评估等方面的运用提供依据。方法:收集2019年01月至2021年12月于河北医科大学第二医院风湿免疫科住院并完善SGUS和唇腺活检(labial salivary gland biopsy,LSGB)确诊为p SS的患者,所有纳入的p SS患者均符合2016年ACR/EULAR的p SS分类标准。依据2019年OMERACT超声工作小组发布的涎腺评分系统及SGUS结果将p SS患者分为SGUS<2分阴性组和≥2分阳性组。对患者一般特征、临床症状、实验室指标及诊断性检查等进行差异性比较分析,同时采用spearman相关性分析对SGUS、LSGB及影响因素进行相关性分析。P<0.05具有统计学差异。结果:1.涎腺超声阴性组患者年龄大于涎腺超声阳性组患者,两组之间存在统计学差异(P<0.05)。将年龄分为<40岁组、40-60岁组、≥60岁组,多组比较存在统计学上差异(P<0.05),在三组之间进行两两比较,<40岁组与≥60岁组之间(P<0.05)存在统计学差异而<40岁组、≥60岁组与40-60岁组之间分别比较均不存在统计学差异(P>0.05)。2.在病程方面,两组间未见统计学差异(P>0.05)。3.涎腺超声阳性组中涎腺肿大患者多于涎腺超声阴性组,且具有统计学差异(P<0.05)。两组之间在口干、眼干、牙齿脱落、发热、关节痛、乏力、肺间质病变、肾小管酸中毒等临床表现方面不存在统计学差异(P>0.05)。4.涎腺超声阳性组与阴性组之间在白细胞计数、血红蛋白、血小板计数、白蛋白、球蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、血清肌酐、C反应蛋白、血沉等常规实验室指标方面均不存在统计学差异(P>0.05)。5.在高水平Ig G、高水平类风湿因子、ANA≥1:320、抗SSA-52KD抗体阳性、抗SSB抗体阳性的方面,涎腺超声阳性组中人数均多于涎腺超声阴性组,且两者之间存在统计学差异(P<0.05)。而在Ig A、Ig M、C3、C4、抗SSA-60KD阳性的方面,两组之间不存在统计学差异(P>0.05)。6.两组患者在Schirmer I试验、角膜染色试验和唾液流率方面都不具有统计学差异(P>0.05)。唇腺病理依据Chisholm-Mason分级系统分为三组即0-2级、3级、4级,多组间的差异比较示P<0.05,具有统计学差异。在三组之间进行两两比较,3级组与4级组之间(P<0.05)存在统计学差异而3级组、4级组分别与0-2级组之间比较均不存在统计学差异(P>0.05)。7.两组之间细胞因子进行比较发现仅IL-17在涎腺超声阴性组的表达高于阳性组,两组间存在统计学差异(P<0.05),而在IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12、IL-12P70、IFN-α、IFN-β和TNF-α方面均未见统计学差异(P>0.05)。8.涎腺超声等级与年龄之间存在负相关(r=-0.285,P<0.05),涎腺超声等级与唇腺病理等级之间存在正相关(r=0.262,P<0.05),年龄与唇腺活检等级之间不存在相关性(P>0.05)。结论1.在p SS患者中SGUS与LSGB存在正相关性,当浸润的淋巴细胞灶>1/4mm2时,SGUS更易出现阳性结果。2.GUS呈负性相关,即年龄越小,更易出现SGUS阳性结果;年龄与LSGB之间不存在相关性3.SGUS和LSGB在p SS诊断中对反映涎腺受累程度具有一致性,可以互为补充,但不能完全取代。4.SGUS阳性患者有高RF、Ig G水平,多种自身抗体阳性及涎腺肿大倾向更多还原

【Abstract】 Objective:To investigate the diagnostic value of salivary gland ultrasonography(SGUS)in primary Sj(?)gren’s Syndrome Syndrome(p SS)and the relationship between SGUS and clinical and laboratory characteristics of p SS,the purpose of this study is to provide evidence for the application of sialography in the diagnosis and evaluation of p SS.Methods:Patients with p SS who had operated SGUS and labial salivary gland biopsy(LSGB)were admitted to the Department of Rheumatology,second hospital of Hebei Medical University from January 2019 to December 2021.All patients’diagnosis of p SS met the 2016 ACR/EULAR classification criteria.The patients with p SS were divided into two groups according to the SGUS and the results of SGUS assessed by the 2019 OMERACT working group ultrasonography scoring system.The general characteristics,clinical symptoms,laboratory indexes and diagnostic examination of patients were compared and analyzed,and the correlation between SGUS,LSGB and influencing factors was analyzed.P<0.05 had statistical difference.Result:1.The age of the patients in the negative group was older than that in the positive group,and there was statistical difference between the two groups(P<0.05).The patients were divided into groups according to age:<40 years old,40-60 years old and≥60 years old.There was a statistical difference(P<0.05),there was statistical difference between the groups<40 years old and≥60 years old(P<0.05),but there was no statistical difference between the groups<40years old or≥60 years old and 40-60 years old(P>0.05).2.There was no significant difference in the course of disease between the two groups(P>0.05).3.There were more patients with salivary gland swelling in the positive group than in the negative group(P<0.05).There was no significant difference in the clinical manifestations of dry mouth,dry eyes,tooth loss,fever,arthralgia,fatigue,interstitial lung disease and renal tubular acidosis between the two groups(P>0.05).4.There was no statistical difference in WBC,HGB,PLT,ALB,GLO,ALT,AST,ALP,GGT,Cr,CRP and ESR between positive and negative groups(P>0.05).5.In high Ig G,high RF,ANA≥1:320,anti-SSA-52KD antibody positive,anti-SSB antibody positive,salivary gland ultrasonography positive group were higher than salivary gland ultrasonography negative group,and there was a statistical difference between the two groups(P<0.05).There was no significant difference in Ig A,Ig M,C3,C4,anti-SSA-60KD between the two groups(P>0.05).6.There was no significant difference between the two groups in Schirmer I test,corneal staining test and salivary flow rate test.According to the Chisholm-Mason classification system,labial glands were divided into three groups,grade 0-2,Grade 3 and Grade 4.The difference between the groups was statistically significant(P<0.05).There was no significant difference between grade 3 group and grade 0-2 Group(P=1),grade4 group and grade0-2group(P=0.81).There was significant difference between the grade 3group and grade 4 Group(P=0.047).7.The expression of IL-17 in the negative group was higher than that in the positive group and there was significant difference between the two groups(P=0.022<0.05),there was no significant difference between positive group and negative group in IL-5,IFNα,IL-2,IL-6,IL-12,IL-10,IFNβ,IL-8,IL-4,IL-12P70,TNF-α(P>0.05).8.There was a negative correlation between SGUS and age(r=-0.285,P<0.05).There was a positive correlation between SGUS and LSGB(r=0.262,P<0.05),there was no correlation between age of onset and grade of lip gland biopsy(P>;0.05).Conclusion:1.There is a positive correlation between SGUS and LSGB in patients with p SS.When FS>1/4mm~2,SGUS was more likely to be observed positive results;2.There was a negative correlation between SGUS and the age,that means the younger the patient is,the more likely to have SGUS positive results.There is no correlation between age and LSGB;3.The SGUS and LSGB are consistent in reflecting the degree of salivary gland involvement in p SS,and can complement each other,but can not replace it completely;4.SGUS positive patients had high RF and Ig G levels,more kinds of autoantibodies positive and salivary gland enlargement tendency.更多还原