超声检查涎腺对干燥综合征的诊断价值研究
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摘要
目的：干燥综合征（Sjogren’s Syndrome, SS）是一种常见的慢性炎症性自身免疫性疾病，主要侵犯涎腺和泪腺等外分泌腺，是一种常见病、多发病，但至今仍无既敏感又特异的单项检查能确诊SS，本课题旨在探讨涎腺彩色多普勒超声及超声腮腺导管生理盐水造影在诊断SS中的作用。
方法：第一部分,选取确诊为干燥综合征的女性32例，分为早期组20例，中晚期组12例。另选同期非干燥综合征女性27例作为对照组，用高频超声检查涎腺，测量并分析其大小，观察其实质回声并分级，用彩色多普勒血流显像(CDFI)检测各腺体动脉，分别测量其PSV、EDV、RI等。第二部分,分别对SS组18例及对照组13例做维生素C酸性刺激,测量并分析刺激前后各腺体动脉PSV、EDV、RI变化情况等。第三部分，对SS患者16例及对照组18例做了超声腮腺导管生理盐水造影,并与X线下泛影葡胺造影结果比较。
结果：1.SS患者涎腺回声不均匀，有多个低回声区，与对照组相比差异有显著性（p<0.05）。2.与对照组相比，早期SS涎腺体积增大而中晚期略有缩小（p<0.05），腮腺导管直径大小无显著差异（p>.05）。3. SS早期组涎腺动脉PSV较对照组升高（p<0.05）， SS中晚期组涎腺动脉PSV、EDV较对照组降低(p<0.05)，而早期组EDV及两SS组RI与对照组相比无显著性差异(p>.05)。4.酸性刺激前后涎腺血流动力学参数变化比较：SS组腮腺PSV增加值及颌下腺PSV、EDV增加值低于对照组(p<0.05)，腮腺EDV增加值及两腺体RI变化值与对照组相比无明显差别(p>.05)。5.超声腮腺导管生理盐水造影与X线下泛影葡胺造影对SS的诊断效率基本一致。
结论：涎腺彩色多普勒超声检查对SS的诊断是有用的、简便的；酸性刺激试验对于彩色多普勒超声检查可疑SS的病例可进一步诊断；超声腮腺导管生理盐水造影是X线下泛影葡胺造影的一种很好的替代检查手段；因此认为超声检查涎腺有助于干燥综合征的诊断。
Objective: Sjogren’s syndrome(SS) is a chronic inflammatory systemic autoimmune disease that predominantly affects exocrine glands such as salivary glands and lacrimal glands. It’s a common disease. But at present, there is no single test which is sufficiently sensitive and specific to form the basis for the diagnosis of SS. The purpose of the study was to evaluate the efficacy of quantitatively ultrasonography of salivary and ultrasonography sialography in the diagnosis of SS.
Metheds: First part: Thirty-two patients with SS were separated into two groups .There were 20 cases in earlier-period group and 12 cases in advanced-period group. There were twenty-seven cases in control group. All of them were underment examination of color Doppler flow imaging(CDFI) and two-dimensconal ultrasonography, size were checked . When the anteries of the glands were checked with CDFI , peak systolic velocity(PSV),end diastolic velocity(EDV),resistant index(RI) were observed. Second part: Stimulation test with vitamin-c was performed on 18 patients in SS group and 13 persons in control group. The changes of the blood flow that may occur before and after the stimulation were measured .Third part: Sixteen cases in SS group and 18 cases in control group were undertook both ultrasonography sialography and X-ray sialography.
Results: 1.Compaired between the two group, different degrees of parenchymal inhomogeneity were the most important sonographic changes in SS (p<0.05). 2. The volume of salivary glands was larger in earlier group than in advanced group. While the volume of that in advanced group are smaller than in the control group (p<0.05). But the diameters of tubes were not significantly wider than that in the control group (p>0.05). 3.The values of PSV in salivary glands are significantly higher in the earlier group than in the control group(p>0.05). While the values of EDV,RI were not significant in statistics. In advanced group the values of PSV ,EDV were lower than that of control group(p<0.05). The values of RI were not significant in statistics(p>.05). 4. After the vitamin-C stimulation test the value of increase of PSV in parotid glands and PSV,EDV in submandebular glands in the group of SS patients were lower than that of control group(p<0.05).The value of increase of EDV ,RI in parotid glands and RI in submandbular glands in the group of SS patients were similar to that of control group(p>0.05).5.The accurate ratios in diagnosis of SS were the same in the whole between the ultrasonography sialography and X-ray sialography.
Conclution: Color doppler ultrasonography of salivary glands is useful and convenient in the diagnosis of SS. The acidity stimulation test can be used to diagnose those cases worthing questioning .Ultrasound sialography is a alternative method which is the same as the classical X-ray sialography in validity. So we suggest Ultrasonography is helpful to the diagnosis of SS.
方法：第一部分,选取确诊为干燥综合征的女性32例，分为早期组20例，中晚期组12例。另选同期非干燥综合征女性27例作为对照组，用高频超声检查涎腺，测量并分析其大小，观察其实质回声并分级，用彩色多普勒血流显像(CDFI)检测各腺体动脉，分别测量其PSV、EDV、RI等。第二部分,分别对SS组18例及对照组13例做维生素C酸性刺激,测量并分析刺激前后各腺体动脉PSV、EDV、RI变化情况等。第三部分，对SS患者16例及对照组18例做了超声腮腺导管生理盐水造影,并与X线下泛影葡胺造影结果比较。
结果：1.SS患者涎腺回声不均匀，有多个低回声区，与对照组相比差异有显著性（p<0.05）。2.与对照组相比，早期SS涎腺体积增大而中晚期略有缩小（p<0.05），腮腺导管直径大小无显著差异（p>.05）。3. SS早期组涎腺动脉PSV较对照组升高（p<0.05）， SS中晚期组涎腺动脉PSV、EDV较对照组降低(p<0.05)，而早期组EDV及两SS组RI与对照组相比无显著性差异(p>.05)。4.酸性刺激前后涎腺血流动力学参数变化比较：SS组腮腺PSV增加值及颌下腺PSV、EDV增加值低于对照组(p<0.05)，腮腺EDV增加值及两腺体RI变化值与对照组相比无明显差别(p>.05)。5.超声腮腺导管生理盐水造影与X线下泛影葡胺造影对SS的诊断效率基本一致。
结论：涎腺彩色多普勒超声检查对SS的诊断是有用的、简便的；酸性刺激试验对于彩色多普勒超声检查可疑SS的病例可进一步诊断；超声腮腺导管生理盐水造影是X线下泛影葡胺造影的一种很好的替代检查手段；因此认为超声检查涎腺有助于干燥综合征的诊断。
Objective: Sjogren’s syndrome(SS) is a chronic inflammatory systemic autoimmune disease that predominantly affects exocrine glands such as salivary glands and lacrimal glands. It’s a common disease. But at present, there is no single test which is sufficiently sensitive and specific to form the basis for the diagnosis of SS. The purpose of the study was to evaluate the efficacy of quantitatively ultrasonography of salivary and ultrasonography sialography in the diagnosis of SS.
Metheds: First part: Thirty-two patients with SS were separated into two groups .There were 20 cases in earlier-period group and 12 cases in advanced-period group. There were twenty-seven cases in control group. All of them were underment examination of color Doppler flow imaging(CDFI) and two-dimensconal ultrasonography, size were checked . When the anteries of the glands were checked with CDFI , peak systolic velocity(PSV),end diastolic velocity(EDV),resistant index(RI) were observed. Second part: Stimulation test with vitamin-c was performed on 18 patients in SS group and 13 persons in control group. The changes of the blood flow that may occur before and after the stimulation were measured .Third part: Sixteen cases in SS group and 18 cases in control group were undertook both ultrasonography sialography and X-ray sialography.
Results: 1.Compaired between the two group, different degrees of parenchymal inhomogeneity were the most important sonographic changes in SS (p<0.05). 2. The volume of salivary glands was larger in earlier group than in advanced group. While the volume of that in advanced group are smaller than in the control group (p<0.05). But the diameters of tubes were not significantly wider than that in the control group (p>0.05). 3.The values of PSV in salivary glands are significantly higher in the earlier group than in the control group(p>0.05). While the values of EDV,RI were not significant in statistics. In advanced group the values of PSV ,EDV were lower than that of control group(p<0.05). The values of RI were not significant in statistics(p>.05). 4. After the vitamin-C stimulation test the value of increase of PSV in parotid glands and PSV,EDV in submandebular glands in the group of SS patients were lower than that of control group(p<0.05).The value of increase of EDV ,RI in parotid glands and RI in submandbular glands in the group of SS patients were similar to that of control group(p>0.05).5.The accurate ratios in diagnosis of SS were the same in the whole between the ultrasonography sialography and X-ray sialography.
Conclution: Color doppler ultrasonography of salivary glands is useful and convenient in the diagnosis of SS. The acidity stimulation test can be used to diagnose those cases worthing questioning .Ultrasound sialography is a alternative method which is the same as the classical X-ray sialography in validity. So we suggest Ultrasonography is helpful to the diagnosis of SS.
引文
Pedersen AM, Nauntofte B.Primary Sjogren’s syndrome:oral aspects.on pathogenesis,diagnostic criteria,clinical features and approaches for therapy. Expert Opin pharmacother, 2001, 2(9):1415~36
陈敏章主编.中华内科学.北京:人民卫生出版社,.1999,3594~3602
Makula E,Pokorny G,Rajtar M, et al. Parotid gland ultrasonography as a diagnostic tool in primary Sjogren’s syndrome.Br Jrheumatol, 1996, 35(10): 972~977
Makula E,Pokorny G,Kiss M, et al. The place of magnetic resonance and ultrasonographicexaminations of the parotid gland in the diagnosis and follow-up of primary Sjogren’s syndrome.Rheumatology (Oxford),2000, 39(1):97~104
Salaffi F,Argalia G,Carotti M, et al. Salivary gland ultrasonography in the evaluation of primary Sjogren’s syndrome.Comparison with minor salivary gland biopsy.J Rheumatol, 2000 ,27(5):1229~1236
周永昌，郭万学主编.超声医学.北京:科学技术文献出版社，1999,360~368
Dost P, Kaiser S.Ultrasonographic biomotry in salivary glands. Ultrasound Med boil,1997,23(9):1299~303
Napoli V,Tozzini A,Neri E, et al. The imaging diagnosis of Sjogren’s syndrome: echography,sialography and scintigraphy compared in the study of the salivary glands.Minerva Stomatol, 1996 ,45(4):141~148
Ahuja AT,Metrewel C.Ultrasound features of Sjogren’s syndrome. Australas Radiol, 1996 ,40(1):10~14
Giovagnorio F, Pace F, Giorgi A.Sonography of lacrimal glands in Sjogren syndrome. J Ultrasound Med, 2000 ,19(8):505~509
Carotti M,Salaffi F,Manganelli P,et al.Ultrasonography and Colour Doppler Sonography of Salivary Glands in Primary Sjogren’s Syndrome. Clinical Rheumatol ,2001.20:213~219
Ariji Y,Ohki M, Eguchi K, et al.Texture analysis of sonographic features of the parotid gland in Sjogren’s syndrome. AJR Am J Roentgenol,1996, 166(4):935~941
叶任高主编.内科学.北京：人民卫生出版社,2000，932-934
Martinoli C,Derchi LE,Solbiati L, et al.Color Doppler sonography of salivary glands. AJR AM J Roentgenol， 1994，163(4):933~941
詹维伟，燕山，龚雷萌，等.涎腺Sjogren’s 综合征的灰阶和彩色超声诊断.中国超声医学杂志,1998,14(2):9~11
Ariji Y,Yuasa H,Ariji E.High-frequency color Doppler sonography of the submandibular gland:relationship between salivary secretion and blood flow. Oral Surg Oral Med Oral Pathol Oral Radial Endod,1998，86(4): 476~481
Chikui T,Yonetsu K,Izumi M, et al. Abnormal blood fiow to the submandibular glands of patients with Sjogren’s syndrome:Doppler waveform analysis. J Rheumatol, 2000,27(5):1222~1228
赵旭兰，赵红卫，张宝牛,等.原发性干燥综合征唾液腺核素显像与唇腺活检病理的相关性分析.中华类风湿病学杂志,2001,5(6):372~374
Yoshiura K,Yuasa K,Tabata O,et al.Reliability of ultrasonography and sialography in the diagnosis of Sjogren’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radial Endod，1997 ，83(3):400~407
陈敏章主编.中华内科学.北京:人民卫生出版社,.1999,3594~3602
Makula E,Pokorny G,Rajtar M, et al. Parotid gland ultrasonography as a diagnostic tool in primary Sjogren’s syndrome.Br Jrheumatol, 1996, 35(10): 972~977
Makula E,Pokorny G,Kiss M, et al. The place of magnetic resonance and ultrasonographicexaminations of the parotid gland in the diagnosis and follow-up of primary Sjogren’s syndrome.Rheumatology (Oxford),2000, 39(1):97~104
Salaffi F,Argalia G,Carotti M, et al. Salivary gland ultrasonography in the evaluation of primary Sjogren’s syndrome.Comparison with minor salivary gland biopsy.J Rheumatol, 2000 ,27(5):1229~1236
周永昌，郭万学主编.超声医学.北京:科学技术文献出版社，1999,360~368
Dost P, Kaiser S.Ultrasonographic biomotry in salivary glands. Ultrasound Med boil,1997,23(9):1299~303
Napoli V,Tozzini A,Neri E, et al. The imaging diagnosis of Sjogren’s syndrome: echography,sialography and scintigraphy compared in the study of the salivary glands.Minerva Stomatol, 1996 ,45(4):141~148
Ahuja AT,Metrewel C.Ultrasound features of Sjogren’s syndrome. Australas Radiol, 1996 ,40(1):10~14
Giovagnorio F, Pace F, Giorgi A.Sonography of lacrimal glands in Sjogren syndrome. J Ultrasound Med, 2000 ,19(8):505~509
Carotti M,Salaffi F,Manganelli P,et al.Ultrasonography and Colour Doppler Sonography of Salivary Glands in Primary Sjogren’s Syndrome. Clinical Rheumatol ,2001.20:213~219
Ariji Y,Ohki M, Eguchi K, et al.Texture analysis of sonographic features of the parotid gland in Sjogren’s syndrome. AJR Am J Roentgenol,1996, 166(4):935~941
叶任高主编.内科学.北京：人民卫生出版社,2000，932-934
Martinoli C,Derchi LE,Solbiati L, et al.Color Doppler sonography of salivary glands. AJR AM J Roentgenol， 1994，163(4):933~941
詹维伟，燕山，龚雷萌，等.涎腺Sjogren’s 综合征的灰阶和彩色超声诊断.中国超声医学杂志,1998,14(2):9~11
Ariji Y,Yuasa H,Ariji E.High-frequency color Doppler sonography of the submandibular gland:relationship between salivary secretion and blood flow. Oral Surg Oral Med Oral Pathol Oral Radial Endod,1998，86(4): 476~481
Chikui T,Yonetsu K,Izumi M, et al. Abnormal blood fiow to the submandibular glands of patients with Sjogren’s syndrome:Doppler waveform analysis. J Rheumatol, 2000,27(5):1222~1228
赵旭兰，赵红卫，张宝牛,等.原发性干燥综合征唾液腺核素显像与唇腺活检病理的相关性分析.中华类风湿病学杂志,2001,5(6):372~374
Yoshiura K,Yuasa K,Tabata O,et al.Reliability of ultrasonography and sialography in the diagnosis of Sjogren’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radial Endod，1997 ，83(3):400~407
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