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        涎腺超聲在原發(fā)性干燥綜合征中的應(yīng)用價(jià)值

        2021-03-15 06:31:23劉麗李延萍吳斌
        中國(guó)現(xiàn)代醫(yī)生 2021年1期
        關(guān)鍵詞:隨訪干燥綜合征診斷

        劉麗 李延萍 吳斌

        [摘要] 原發(fā)性干燥綜合征(pSS)是一種臨床常見的自身免疫性疾病,主要侵犯唾液腺和淚腺等外分泌腺體。目前常用的檢查包括腮腺造影、腮腺核素顯像、唇腺活檢等。近年來涎腺超聲(SGU)發(fā)展迅速,較傳統(tǒng)的檢查方法有著簡(jiǎn)便、經(jīng)濟(jì)、無創(chuàng)、易于操作和推廣等優(yōu)勢(shì),本文就SGU在pSS診療中的應(yīng)用及研究進(jìn)展進(jìn)行綜述。從pSS的SGU成像特征探討其診斷價(jià)值;從SGU評(píng)分與臨床癥狀、實(shí)驗(yàn)室指標(biāo)的聯(lián)系來分析預(yù)后;從治療后唾液腺的回聲改變分析SGU用于療效監(jiān)測(cè)和隨訪的可行性。

        [關(guān)鍵詞] 干燥綜合征;涎腺超聲;診斷;療效;隨訪

        [Abstract] Primary sjgren's syndrome(pSS) is a common autoimmune disease in clinic, which mainly invades salivary glands and lacrimal glands. At present, the commonly used examinations include parotid radiography, parotid radionuclide imaging, lip gland biopsy and so on. Salivary gland ultrasonography(SGU) has developed rapidly in recent years. Compared with traditional examination methods, SGU has the advantages of simplicity, economy, non-invasion, easy operation and wide popularization. This article reviews the application and research progress of SGU in diagnosis and treatment of pSS. The diagnostic value of pSS was discussed from its SGU imaging features. The prognosis was analyzed from the relationship between SGU score and clinical symptoms and laboratory indicators. The feasibility of SGU in curative effect monitoring and follow-up was analyzed from the echo changes of salivary glands after treatment.

        [Key words] Sjogren's syndrome; Salivary gland ultrasonography; Diagnosis; Efficacy; Follow-up

        原發(fā)性干燥綜合征(Primary sjgren's syndrome,pSS)是一個(gè)多種病因相互作用的慢性炎癥性自身免疫性疾病,以口腔和眼部干燥為主要特征[1]。在其病理變化過程中,主要表現(xiàn)為唾液腺等腺體的導(dǎo)管管腔異常,腺上皮細(xì)胞呈進(jìn)行性破壞或萎縮、功能受損,小血管壁或血管周圍炎癥細(xì)胞浸潤(rùn)致使局部組織供血不足[2]。小唾液腺活檢是pSS診斷的重要手段,但不適合重復(fù)隨訪[3]。迄今為止,有多種成像技術(shù)可用于評(píng)估腮腺(如唾液造影、唾液腺閃爍顯像術(shù)等);然而這些技術(shù)受到其侵入性或高成本的限制[4]。涎腺超聲(Salivary gland ultrasonography,SGU)已經(jīng)在pSS中使用,并發(fā)現(xiàn)能與造影顯像和MRI相媲美;該方法主要優(yōu)點(diǎn)為迅速性、可重復(fù)性和低成本[5]。SGU檢查手段也有多種,包括灰階超聲、多普勒超聲、脈沖頻譜多普勒(Pulsed wave doppler,PW)等,其可以觀察涎腺的形態(tài)、回聲、質(zhì)地、側(cè)后聲影、境界和包膜,提供病變部位的血流特征。非侵入性的SGU在pSS的診斷中發(fā)揮著重要作用,對(duì)唾液腺結(jié)構(gòu)異常的直接可視化有利于對(duì)腺實(shí)質(zhì)的回聲、同質(zhì)性、纖維化和鈣化進(jìn)行分類,其已廣泛用于評(píng)估pSS涎腺的病變和治療反應(yīng)[6-7]。本文就SGU的應(yīng)用價(jià)值及研究進(jìn)展綜述如下。

        1 干燥綜合征患者的超聲涎腺成像特征

        1.1 評(píng)分系統(tǒng)

        1992年,De[8]等指出SGU在干燥綜合征(Sjgren's syndrome,SS)診斷中具有潛在價(jià)值;該研究發(fā)現(xiàn)腺體回聲不均是SS的特征性表現(xiàn),并按不均勻程度、低回聲結(jié)節(jié)大小提出0~4分涎腺超聲評(píng)分(SGU scoring system,SGUS)分別對(duì)4個(gè)腺體進(jìn)行評(píng)分。0分:正常腺體,回聲均勻;1分:輕度不均勻;2分:明顯不均勻,低回聲結(jié)節(jié)<2 mm;3分:低回聲結(jié)節(jié)直徑2~6 mm;4分:低回聲結(jié)節(jié)>6 mm。取最高值為最終值,以≥2分為界診斷性能較好;但應(yīng)排除同樣表現(xiàn)為不均勻回聲的急性腮腺炎。后來,多位學(xué)者有不同報(bào)道,如Fidelix等[6]簡(jiǎn)化評(píng)分系統(tǒng),按0~4等級(jí)分級(jí),0級(jí)=正常,1級(jí)=沒有回聲帶的小低回聲區(qū),2級(jí)=回聲<2 mm的多個(gè)低回聲區(qū)條帶,3級(jí)=多個(gè)2~6 mm低回聲區(qū)域,具有高回聲帶,4級(jí)=多個(gè)>6 mm低回聲區(qū)域或多重鈣化,具有回聲帶。而Theander等[9]將實(shí)質(zhì)同質(zhì)性按0~3分級(jí):0=完全均勻,1=輕度不均勻,2=明顯不均勻,3=總不均勻,4個(gè)唾液腺的總分為最終得分。近年來,國(guó)內(nèi)外學(xué)者在0~4分SGUS基礎(chǔ)上將評(píng)分條目更細(xì)致化,提出10~12、0~16、0~48分SGUS[10-11];但因操作相對(duì)復(fù)雜、對(duì)操作者技術(shù)及經(jīng)驗(yàn)要求高,且臨界值存在爭(zhēng)議而未像0~4分SGUS 得到廣泛應(yīng)用[12-13]。鑒于0~4評(píng)分系統(tǒng)比其他系統(tǒng)具有更少的異質(zhì)性,且操作簡(jiǎn)單、時(shí)間短,因此可用作通用的SGU診斷標(biāo)準(zhǔn)[7]。由上可知,簡(jiǎn)化的0~4級(jí)評(píng)分系統(tǒng)敏感性更高,操作方便,易于在pSS中推廣使用。

        1.2 成像特征

        SS的涎腺成像特征隨疾病的階段而變化。李居獻(xiàn)等[14]將pSS涎腺特征總結(jié)如下:①隨著疾病的發(fā)展,腺體大小及形態(tài)發(fā)生變化、輪廓模糊;②實(shí)質(zhì)回聲局灶性及彌散性低回聲變化;③血流信號(hào)發(fā)生改變。且Lee等[15]發(fā)現(xiàn)與沒有明確SGU結(jié)構(gòu)異常的患者相比,晚期pSS患者的腮腺和下頜下腺體積更小,功率多普勒信號(hào)降低更多。同時(shí),齊晅等[16]研究得出唾液腺的回聲不均及低回聲結(jié)節(jié)是pSS最有意義的征象。其他研究也論證了pSS涎腺超聲的唯一特質(zhì)是實(shí)質(zhì)異質(zhì)性,定義為存在低/無回聲區(qū)或高回聲區(qū)域[17],體積增大或減小以及氣管周圍腺淋巴結(jié)的存在;所有異質(zhì)腺均顯示出更多的血流信號(hào)[18-19]。綜上可得,pSS患者涎腺超聲的成像特征如下:早期為回聲的輕度不均勻性伴或不伴血流信號(hào);中期彌漫性回聲不均伴多發(fā)低回聲結(jié)節(jié)(直徑多小于6 mm),血流信號(hào)增多;晚期纖維化萎縮或多發(fā)結(jié)節(jié)(直徑>6 mm),而血流信號(hào)隨著疾病進(jìn)展逐漸減少。

        2 涎腺超聲對(duì)pSS的診斷價(jià)值

        2.1 較高的敏感度

        自1972年Maridis首先將超聲用于腮腺檢查以來,超聲已成為診斷唾液腺疾病的重要手段之一。小唾液腺的唾液造影和活檢是診斷SS的既定和客觀檢查,然而這些程序的有創(chuàng)性和并發(fā)癥限制了它們的臨床用途。研究表明SGU是同造影及唇腺活檢高度一致的,具有很高的pSS診斷準(zhǔn)確度[7,20]。過去20年發(fā)表的大量研究報(bào)告顯示,超聲對(duì)pSS診斷的敏感性為70%,特異性>90%[21]。Shimizu等[22]比較去氧葡萄糖正子斷層造影(FDG-PET)、CT、MRI、超聲檢查唾液腺的靈敏度、特異性和準(zhǔn)確性,超聲顯示最高水平;并且多項(xiàng)研究結(jié)果均顯示,無論使用何種分級(jí)系統(tǒng),SGUS都具有高度特異性且總是具有>60%的靈敏度,有助于pSS的診斷,可有效地納入將來的分類標(biāo)準(zhǔn)。如Cornec等[23]研究發(fā)現(xiàn),在2012年美國(guó)風(fēng)濕病學(xué)會(huì)(ACR)分類標(biāo)準(zhǔn)中增加SGUS后,其敏感性從64.4%提高到84.4%,特異性不變。SGUS可以同時(shí)適用于SS的AECG和ACR/EULAR分類標(biāo)準(zhǔn),腮腺的SGUS具有更高的特異性,而下頜下腺的敏感性更高[24]。Le等[25]將疑似pSS患者接受包括SGUS在內(nèi)的標(biāo)準(zhǔn)化評(píng)估,結(jié)果表明SGUS作為客觀評(píng)估外分泌腺受累的替代程序可進(jìn)一步提高敏感性。還有研究發(fā)現(xiàn),將SGUS作為ACR/EULAR2016分類標(biāo)準(zhǔn)的內(nèi)容,可將敏感性從90.2%提高到95.6%,而不改變特異性[26]。此外,腮腺薄壁組織中的血管信息可能是超聲診斷SS的另一客觀征象。血管異常與組織病理學(xué)分級(jí)有關(guān),但與唾液譜分級(jí)無關(guān)。通過增加血管信息,SGUS的敏感性、特異性和準(zhǔn)確性分別從44%、97%和65%變?yōu)?3%、90%和74%。并且SGUS的診斷特性沒有跟隨疾病時(shí)間而變化,可以早期發(fā)現(xiàn)pSS唾液腺的異常[23,27-28]??梢奡GUS能提高pSS診斷的靈敏度。

        2.2 良好的診斷性能

        SGU是診斷SS的高度特異性的成像方法。Baldini等[29]比較了SGUS與小唾液腺活檢和未受刺激的唾液流量的診斷性能,結(jié)果證實(shí)SGUS可將pSS與繼發(fā)性SS區(qū)別開來,對(duì)pSS的早期診斷表現(xiàn)出良好的性能。SGUS臨界值≥1時(shí)診斷pSS的特異性為98%,陽性預(yù)測(cè)值為97%,陰性預(yù)測(cè)值為73%。Luciano等[30]也指出SGU是辨別pSS與未分化結(jié)締組織疾病及干燥癥狀不符合SS標(biāo)準(zhǔn)的患者的有用工具,將SGUS截?cái)嘣u(píng)分設(shè)置為>2時(shí)診斷SS的特異性為96%,陽性預(yù)測(cè)值為95%,陰性預(yù)測(cè)值為73%。此外,在對(duì)小唾液腺組織病理學(xué)和大唾液腺超聲檢查的盲法回顧性研究中,SGUS與組織病理學(xué)的總體一致性為91%[31]。后來,Takagi 等[32]回顧性評(píng)估了聯(lián)合使用SGUS和2016年美國(guó)風(fēng)濕病學(xué)會(huì)/歐洲抗風(fēng)濕病聯(lián)盟(ACR/EULAR)分類標(biāo)準(zhǔn)的有效性,對(duì)于原發(fā)性和繼發(fā)性SS,診斷準(zhǔn)確率分別為77%和79%。最近,王嬌嬌等[33]將SGU與實(shí)時(shí)剪切波彈性成像兩者聯(lián)合診斷pSS,使敏感性(88.2%)和準(zhǔn)確率(86.8%)均明顯提高,特異性又無明顯下降(90.6%)。但彈性成像過程中預(yù)先加壓等因素均會(huì)影響檢查結(jié)果,致使SGU的診斷效能在各個(gè)研究中變化較大[34]。簡(jiǎn)言之,SGUS使用四個(gè)主要唾液腺的等級(jí)總和表現(xiàn)出最佳的診斷性能,對(duì)主要唾液腺的實(shí)質(zhì)不均勻性進(jìn)行評(píng)分是最簡(jiǎn)單的方法[35-36]。總之,SGUS可用于診斷pSS并改善分類標(biāo)準(zhǔn)的診斷性能,但仍缺乏廣泛認(rèn)可的國(guó)際標(biāo)準(zhǔn)。

        3 涎腺超聲對(duì)pSS的預(yù)測(cè)價(jià)值

        唾液腺的詳細(xì)評(píng)估對(duì)于預(yù)測(cè)淋巴瘤的風(fēng)險(xiǎn)至關(guān)重要[37]。大量研究支持SGUS對(duì)pSS患者的預(yù)后分層有用,通常下頜下腺的病理變化比腮腺更早,并經(jīng)常伴有腮腺變化。而且SGUS與pSS患者的血清學(xué)檢查陽性率、疾病活動(dòng)性及淋巴瘤風(fēng)險(xiǎn)呈正相關(guān),例如唾液腺腫脹、皮膚血管炎,唾液腺組織活檢中的生發(fā)中心樣結(jié)構(gòu)及CD4+ T淋巴細(xì)胞減少癥等發(fā)生率更高[9,38-39]。如Hammenfors等[40]發(fā)現(xiàn)患者的干燥、疲勞和血清學(xué)改變的程度與SGU上嚴(yán)重的實(shí)質(zhì)改變有關(guān)。在選定的pSS患者中,SGUS與唾液腺炎癥呈正相關(guān),與其功能呈負(fù)相關(guān)[41]。Fidelix等[6]研究發(fā)現(xiàn)SGU評(píng)分為1分或2分的患者顯示出比評(píng)分為3分或4分的患者更高的唾液流量,且抗Ro/SSA組的評(píng)分高于抗La/SSB組,提出SGU可作為需要更密切隨訪的患者的有用工具。此外,SGU評(píng)分較高的患者發(fā)生系統(tǒng)并發(fā)癥的頻率也更高[42]。在最近的隊(duì)列研究中系統(tǒng)受累患者的涎腺受累更為嚴(yán)重,SGU評(píng)分異常的患者具有較高的抗Ro/SSA和/或抗La/SSB陽性率、ANA陽性率、RF陽性率和高球蛋白血癥[30,43]。高SGU評(píng)分對(duì)中/高度的ESSDAI和SSDAI具有較高的預(yù)測(cè)價(jià)值[44]。可見SGU評(píng)分高的患者因預(yù)后不良的風(fēng)險(xiǎn)增加而需要更加密切地隨訪。在pSS疾病活動(dòng)性和損害評(píng)估中,建議定期進(jìn)行唾液腺超聲檢查,以提供腺實(shí)質(zhì)狀態(tài)的補(bǔ)充視圖并監(jiān)測(cè)淋巴瘤的發(fā)展。

        4 涎腺超聲在治療及隨訪中的應(yīng)用

        4.1 療效評(píng)價(jià)

        在治療研究中,超聲也可能被視為參數(shù)或終點(diǎn)[40]。Jousse-Joulin等[45]在第1次利妥昔單抗輸注前后6個(gè)月分別使用B模式成像和脈沖多普勒評(píng)估pSS唾液腺回聲結(jié)構(gòu)和血管情況,結(jié)果支持一些唾液腺回聲變化的可逆性,但并未顯著改變唾液腺大小及血管情況,該研究首次證實(shí)了pSS治療后SGU的變化。Takagi等[46]進(jìn)一步研究表明,SGUS的嚴(yán)重程度還與對(duì)口干癥治療的反應(yīng)有關(guān),SGUS的改善可能表明具有治療效果。Cornec等[21]也發(fā)現(xiàn)接受利妥昔單抗治療的患者6個(gè)月后的SGUS改善,提示唾液腺病變是可逆的。后來,F(xiàn)isher等[47]比較利妥昔單抗與安慰劑對(duì)pSS中SGUS的影響,也顯示出利妥昔單抗組超聲評(píng)分的顯著改善。國(guó)內(nèi)學(xué)者在SGUS療效評(píng)價(jià)方面也有研究,如徐江喜[48]探討?zhàn)龆咀CpSS患者接受活血解毒方治療前后SGU的變化,與對(duì)照組相比,治療組SGU評(píng)分及相關(guān)指標(biāo)均有改善。又如徐麗萍等[49]探究益氣消毒方對(duì)SS患者腮腺病變的影響,以益氣消毒方加減治療3個(gè)月以上,且治療前后均行涎腺超聲檢查;結(jié)果顯示pSS患者出現(xiàn)SGUS改變的比例顯著高于繼發(fā)性SS,證明SGU在評(píng)價(jià)益氣消毒方對(duì)pSS的治療效果方面有價(jià)值。以上研究支持SGU在監(jiān)測(cè)pSS臨床治療效果方面的有用性,可在這方面進(jìn)行更多的研究以增加一種新的療效評(píng)估手段。

        4.2 隨訪

        超聲在選擇需要進(jìn)一步隨訪的患者中也具有一定作用;鑒于唾液腺組織學(xué)測(cè)量的可重復(fù)性,SGU作為潛在的測(cè)量組織病理學(xué)標(biāo)準(zhǔn)化的進(jìn)一步驗(yàn)證工作是非常需要且必要的[4,18,50]。Gazeau等[18]發(fā)現(xiàn)在對(duì)可疑pSS患者進(jìn)行初步評(píng)估后近兩年的隨訪中,使用半定量評(píng)分評(píng)估的SGUS均未發(fā)生明顯變化。而張雪珍等[51]對(duì)pSS患者給予硫唑嘌呤治療后6、12個(gè)月進(jìn)行隨訪,結(jié)果顯示早期組患者治療后涎腺均有縮小,晚期組未見明顯變化;血流動(dòng)力學(xué)變化幅度不大。Lee等[52]將pSS患者進(jìn)行了基線SGU掃描,并在兩年后進(jìn)行隨訪,評(píng)估半定量SGUS(0~48)和腺內(nèi)血流信號(hào);pSS患者的SGUS提高了18.6%。同質(zhì)性和低回聲區(qū)域是顯示出明顯進(jìn)展的區(qū)域,腺體內(nèi)血管過多與唾液腺異常惡化相關(guān),這為pSS的腺體進(jìn)展提供了潛在的預(yù)測(cè)指標(biāo)。此外,當(dāng)監(jiān)測(cè)pSS的活動(dòng)性或進(jìn)展時(shí),建議在每個(gè)時(shí)間點(diǎn)由同一位檢查者對(duì)患者進(jìn)行評(píng)分。因?yàn)殡S著時(shí)間的推移,觀察到的SGU變化不僅歸因于疾病的進(jìn)展或藥物作用,還可能部分歸因于不同觀察者之間存在的評(píng)分差異[53]。鑒于SGUS用于pSS隨訪效果不一,仍需進(jìn)行長(zhǎng)時(shí)間深入隨訪以探究SGUS在不同時(shí)間點(diǎn)的變化。

        綜上所述,SGU對(duì)pSS的診斷、療效監(jiān)測(cè)及預(yù)后評(píng)估均具有潛在價(jià)值。涎腺超聲可用于觀察pSS患者的唾液腺形態(tài)、回聲、血流信號(hào)等,具有較高的臨床診斷價(jià)值,可作為一種新穎無創(chuàng)的診斷及隨訪手段,并降低早期pSS的漏診率,且超聲檢測(cè)技術(shù)在長(zhǎng)時(shí)間的隨訪中,具有使用方便、可重復(fù)性高、更易為患者所受的優(yōu)點(diǎn)。此外,SGU在pSS診療中的應(yīng)用屬當(dāng)前研究熱點(diǎn)之一,尤其是在早期診斷與療效評(píng)估方面得到了較多認(rèn)可。因此,未來的研究將需要長(zhǎng)期隨訪不同治療策略在pSS中的效應(yīng),并更好地確定SGUS在治療后的變化,以期全面提高涎腺超聲對(duì)pSS的診斷及病情評(píng)估水平,使之成為診斷pSS、估計(jì)預(yù)后及評(píng)估治療反應(yīng)的有用工具。

        [參考文獻(xiàn)]

        [1] Fiche A,Menezes AV,Valerio CS,et al. Clinical,imaging,and laboratory findings in sj?觟gren's syndrome[J]. United States,2017,38(8):520-525.

        [2] Carubbi F,Alunno A,Gerli R,et al. Histopathology of salivary glands[J]. Reumatismo,2018,70(3):146-154.

        [3] Bhatia KSSB,Dai YMMM. Routine and advanced ultrasound of major salivary glands[J]. Neuroimaging Clinics of North America,2018,28(2):273-293.

        [4] Martire MV,Santiago ML,Cazenave T,et al. Latest advances in ultrasound assessment of salivary glands in sjogren syndrome[J]. J Clin Rheumatol,2018,24(4):218-223.

        [5] Sch?覿fer VS,Schmidt WA. Ultraschalldiagnostik beim Sj?觟gren-Syndrom[J]. Zeitschrift Für Rheumatologie,2017, 76(7):589-594.

        [6] Fidelix T,Czapkowski A,Azjen S,et al. Salivary gland ultrasonography as a predictor of clinical activity in Sjogren's syndrome[J]. PLoS One,2017,12(8):e182 287.

        [7] Zhou M,Song S,Wu S,et al. Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjogren's syndrome:A systematic review and meta-analysis[J]. Sci Rep,2018,8(1):17 128.

        [8] De Vita S,Lorenzon G,Rossi G,et al. Salivary gland echography in primary and secondary Sjogren's syndrome[J].Clin Exp Rheumatol,1992,10(4):351-356.

        [9] Theander E,Mandl T. Primary sjogren's syndrome:Diagnostic and prognostic value of salivary gland ultrasonography using a simplified scoring system[J]. Arthritis Care Res (Hoboken),2014,66(7):1102-1107.

        [10] Zhang X,Zhang S,He J,et al. Ultrasonographic evaluation of major salivary glands in primary Sjogren's syndrome:Comparison of two scoring systems[J]. Rheumatology (Oxford),2015,54(9):1680-1687.

        [11] Lin D,Yang W,Guo X,et al. Cross-sectional comparison of ultrasonography scoring systems for primary Sjogren's syndrome[J]. Int J Clin Exp Med,2015,8(10):19 065-19 071.

        [12] 楊蘆莎,王志剛,張群霞. 干燥綜合征涎腺病變的影像學(xué)研究進(jìn)展[J]. 中國(guó)醫(yī)學(xué)影像學(xué)雜志,2017,25(12):956-960.

        [13] Martel A,Coiffier G,Bleuzen A,et al. What is the best salivary gland ultrasonography scoring methods for the diagnosis of primary or secondary Sjogren's syndromes?[J].Joint Bone Spine,2019,86(2):211-217.

        [14] 李居獻(xiàn),楊廣輝,孔凡沛,等. 超聲評(píng)分系統(tǒng)在干燥綜合征中的診斷價(jià)值[J]. 臨床醫(yī)藥文獻(xiàn)電子雜志,2018, 5(75):152-153.

        [15] Lee KA,Lee SH,Kim HR. Diagnostic and predictive evaluation using salivary gland ultrasonography in primary sjogren's syndrome[J]. Clin Exp Rheumatol,2018,112(3):165-172.

        [16] 齊晅,孫超,田玉,等. 雙側(cè)腮腺的唾液腺超聲評(píng)分系統(tǒng)對(duì)原發(fā)性干燥綜合征的診斷價(jià)值[J]. 河北醫(yī)藥 2018, 40(16):2499-2501,2505.

        [17] James-Goulbourne T,Murugesan V,Kissin EY. Sonographic features of salivary glands in sj?觟gren's syndrome and its mimics[J]. Current Rheumatology Reports,2020,22(8):36.

        [18] Gazeau P,Cornec D,Jousse-Joulin S,et al. Time-course of ultrasound abnormalities of major salivary glands in suspected sjogren's syndrome[J]. Joint Bone Spine,2018, 85(2):227-232.

        [19] Mossel E,Delli K,van Nimwegen JF,et al. Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary sj?觟gren's syndrome[J]. Annals of the Rheumatic Diseases,2017,76(11):1883-1889.

        [20] Martire MV,Santiago ML,Cazenave T,et al. Latest advances in ultrasound assessment of salivary glands in sj?觟gren syndrome[J]. Journal of Clinical Rheumatology,2018,24(4):218-223.

        [21] Cornec D,Devauchelle-Pensec V,Saraux A,et al. Clinical usefulness of salivary gland ultrasonography in sjogren's syndrome: Where are we now?[J]. Rev Med Interne,2016,37(3):186-194.

        [22] 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 sjogren's syndrome(SS),with an emphasis on sonography[J]. Arthritis Res Ther,2015,17(1):223.

        [23] Cornec D,Jousse-Joulin S,Marhadour T,et al. Salivary gland ultrasonography improves the diagnostic performance of the 2012 American college of rheumatology classification criteria for sjogren's syndrome[J]. Rheumatology(Oxford),2014,53(9):1604-1607.

        [24] Kim JW,Lee H,Park SH,et al. Salivary gland ultrasonography findings are associated with clinical,histological,and serologic features of Sjogren's syndrome[J]. Scand J Rheumatol,2018,47(4):303-310.

        [25] Le Goff M,Cornec D,Jousse-Joulin S,et al. Comparison of 2002 AECG and 2016 ACR/EULAR classification criteria and added value of salivary gland ultrasonography in a patient cohort with suspected primary Sjogren's syndrome[J]. Arthritis Res Ther,2017,19(1):269.

        [26] Jousse Joulin S,Gatineau F,Baldini C,et al. Weight of salivary gland ultrasonography compared to other items of the 2016 ACR/EULAR classification criteria for Primary Sj?觟gren's syndrome[J]. Journal of Internal Medicine,2019,287(2):180-188.

        [27] Cornec D,Jousse-Joulin S,Pers JO,et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjogren's syndrome:Toward new diagnostic criteria?[J]. Arthritis Rheum,2013,65(1):216-225.

        [28] Takagi Y,Sumi M,Nakamura H,et al. Ultrasonography as an additional item in the American college of rheumatology classification of sjogren's syndrome[J]. Rheumatology (Oxford),2014,53(11):1977-1983.

        [29] Baldini C,Luciano N,Tarantini G,et al. Salivary gland ultrasonography:A highly specific tool for the early diagnosis of primary Sjogren's syndrome[J]. Arthritis Res Ther,2015,17(1):146.

        [30] Luciano N,Baldini C,Tarantini G,et al. Ultrasonography of major salivary glands:A highly specific tool for distinguishing primary sjogren's syndrome from undifferentiated connective tissue diseases[J]. Rheumatology(Oxford),2015,54(12):2198-2204.

        [31] Astorri E,Sutcliffe N,Richards PS,et al. Ultrasound of the salivary glands is a strong predictor of labial gland biopsy histopathology in patients with sicca symptoms[J]. J Oral Pathol Med,2016,45(6):450-454.

        [32] Takagi Y,Nakamura H,Sumi M,et al. Combined classification system based on ACR/EULAR and ultrasonographic scores for improving the diagnosis of Sjogren's syndrome[J]. PLoS One,2018,13(4):e195 113.

        [33] 王嬌嬌,張磊,劉升云, 等. 實(shí)時(shí)剪切波彈性成像聯(lián)合超聲評(píng)分在原發(fā)性干燥綜合征腮腺受損診斷中的價(jià)值[J]. 中國(guó)臨床醫(yī)學(xué)影像雜志,2019,30(11):773-777.

        [34] 羅藝,郝少云. 涎腺超聲在干燥綜合征中的應(yīng)用價(jià)值[J].實(shí)用醫(yī)學(xué)影像雜志,2019,20(4):381-383.

        [35] Mossel E,Arends S,van Nimwegen JF,et al. Scoring hypoechogenic areas in one parotid and one submandibular gland increases feasibility of ultrasound in primary sj?觟gren's syndrome[J]. Annals of the Rheumatic Diseases,2018,77(4):556-562.

        [36] Jousse-Joulin S,Milic V,Jonsson MV,et al. Is salivary gland ultrasonography a useful tool in sjogren's syndrome? A systematic review[J]. Rheumatology(Oxford),2016, 55(5):789-800.

        [37] Nocturne G,Virone A,Ng WF,et al. Rheumatoid factor and disease activity are independent predictors of lymphoma in primary sjogren's syndrome[J]. Arthritis Rheumatol,2016,68(4):977-985.

        [38] Baldini C,Luciano N,Mosca M,et al. Salivary gland ultrasonography in sjogren's syndrome:Clinical usefulness and future perspectives[J]. Isr Med Assoc J,2016,18(3-4):193-196.

        [39] Silva JL,F(xiàn)aria DS,Neves JS,et al. Salivary gland ultrasound findings are associated with clinical and serologic features in primary sj?觟gren's syndrome patients[J]. Acta Reumatológica Portuguesa,2020,2020(1):76-77.

        [40] Hammenfors DS,Brun JG,Jonsson R,et al. Diagnostic utility of major salivary gland ultrasonography in primary sjogren's syndrome[J]. Clin Exp Rheumatol,2015,33(1):56-62.

        [41] Samier-Guerin A,Saraux A,Gestin S,et al. Can ARFI elastometry of the salivary glands contribute to the diagnosis of sjogren's syndrome?[J]. Joint Bone Spine,2016, 83(3):301-306.

        [42] Carotti M,Salaffi F,Di Carlo M,et al. Diagnostic value of major salivary gland ultrasonography in primary Sjogren's syndrome:The role of grey-scale and colour/power doppler sonography[J]. Gland Surg,2019,8(Suppl 3):S159-S167.

        [43] Inanc N,Sahinkaya Y,Mumcu G,et al. Evaluation of salivary gland ultrasonography in primary sjogren's syndrome:Does it reflect clinical activity and outcome of the disease?[J]. Clin Exp Rheumatol,2019,37 Suppl 118(3):140-145.

        [44] Jousse-Joulin S,D'Agostino MA,Ho■evar A,et al. Could we use salivary gland ultrasonography as a prognostic marker in sjogren's syndrome? Response to:‘Ultrasonographic damages of major salivary glands are associated with cryoglobulinemic vasculitis and lymphoma in primary Sjogren's syndrome:Are the ultrasonographic features of the salivary glands new prognostic markers in Sjogren's syndrome?' by Coiffier et al[J]. Annals of the Rheumatic Diseases,2019:2019-216327.

        [45] Jousse-Joulin S,Devauchelle-Pensec V,Cornec D,et al. Brief report:Ultrasonographic assessment of salivary gland response to rituximab in primary sjogren's syndrome[J]. Arthritis Rheumatol,2015,67(6):1623-1628.

        [46] Takagi Y,Sumi M,Nakamura H,et al. Salivary gland ultrasonography as a primary imaging tool for predicting efficacy of xerostomia treatment in patients with sjogren's syndrome[J]. Rheumatology(Oxford),2016,55(2):237-245.

        [47] Fisher BA,Everett CC,Rout J,et al. Effect of rituximab on a salivary gland ultrasound score in primary sjogren's syndrome:Results of the TRACTISS randomised double-blind multicentre substudy[J]. Ann Rheum Dis,2018,77(3):412-416.

        [48] 徐江喜. 活血解毒方治療原發(fā)性干燥綜合征瘀毒證的療效評(píng)價(jià)[D]. 北京:北京中醫(yī)藥大學(xué),2019.

        [49] 徐麗萍,戴巧定,關(guān)天容,等. 益氣消毒方對(duì)干燥綜合征患者腮腺超聲病變影響的研究[J]. 浙江中醫(yī)藥大學(xué)學(xué)報(bào),2019,43(9):978-982.

        [50] Fisher BA,Emery P,Pitzalis C,et al. Response to:Can ultrasound of the major salivary glands assess histopathological changes induced by treatment with rituximab in primary sjogren's syndrome?[J]. Ann Rheum Dis,2019,78(4):e28.

        [51] 張雪珍,林一欽,何麗珍,等. 涎腺超聲檢測(cè)在原發(fā)性干燥綜合征診斷與隨訪中的應(yīng)用價(jià)值[J]. 浙江醫(yī)學(xué),2018,40(11):1261-1264.

        [52] Lee KA,Lee SH,Kim HR. Ultrasonographic changes of major salivary glands in primary sjogren's syndrome[J]. J Clin Med,2020,9(3):803.

        [53] Delli K,Arends S,Van Nimwegen JF,et al. Ultrasound of the major salivary glands is a reliable imaging technique in patients with clinically suspected primary sjogren's syndrome[J]. Ultraschall Med, 2018,39(3):328-333.

        (收稿日期:2020-09-11)

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