结膜印迹细胞学在干燥综合征患者干眼诊断中的应用及相关免疫学影响因素分析

目的:探讨结膜印迹细胞学检查在pSS诊断中的作用及相关结膜病变的免疫学影响因素。方法:纳入以干眼为主诉的患者57例,其中pSS患者38例,非pSS患者19例。对所有患者进行结膜印迹细胞学检查,并用Nelson法评分。pSS中31例进行了自身抗体、免疫球蛋白、补体等血清学检查。采用t检验及秩和检验比较相关数据之关联。结果:以结膜印迹细胞学Nelson分级≥2级为阳性界值,结膜印迹细胞学在pSS诊断的敏感度为68.4%,特异度为89.5%,受试者工作特征曲线(ROC)曲线下面积为0.767。在pSS患者中,结膜印迹细胞学检查的不同Nelson分级之间,ANA(χ^2=4.664,P=0.031)、抗SSA抗体(χ^2=8.58,P<0.01)、抗SSB抗体(χ^2=6.13,P=0.013)、抗SSA-52抗体(χ^2=6.48,P=0.011)、IgG(t=-4.344,P<0.01)和RF(U=25.0,P<0.01)差异具有统计学意义。结论:结膜印迹细胞学检查在pSS的诊断中有一定价值,可作为评估SS结膜病变的重要依据。血清ANA、抗SSA抗体、抗SSB抗体、抗SSA-52抗体、IgG、RF水平与结膜病变程度有显著相关,可能是结膜受累的免疫学诱发因素。

The role of conjunctival impression cytology in the diagnosis of Sjogren's syndrome and the immu-nological factors influencing conjunctival lesions

Objective To investigate the role of conjunctival impression cytology in the diagnosis of Sj?gren's syndrome(SS)and the immunological factors influencing conjunctival lesions.Methods A total of 57 patients complaining about dry eye were collected,including 38 patients with primary Sj?gren's syndrome(pSS)and 19 patients with non-SS.Conjunctival impression cytology tests were performed for all patients,and they were scored by the Nelson method.Thirty-one patients with SS underwent serological tests such as autoantibodies,immunoglobulins,and complement.The correlation between the relevant data was compared using the t test and the rank sum test.Results The Nelson grade≥2 is the positive cut-off value for the diagnosis of SS.The sensitivity was 68.4%,and the specificity was 89.5%,and the area under the receiver operating characteristic curve(ROC)was 0.767.In patients with SS,there was statistical correlation between the results of conjunctival impression cytology and antinuclear antibody(ANA)(χ^2=4.664,P=0.031),anti-SSA antibody(χ^2=8.58,P<0.01),anti-SSB antibody(χ^2=6.13,P=0.013),anti-SSA-52 antibody(χ^2=6.48,P=0.011),immunoglobulin(Ig)G(t=-4.344,P<0.01)and rheumatoid factor(RF)(U=25.0,P<0.01).Conclusion Con-junctival impression cytology has certain value in the diagnosis of SS and can be used to evaluate conjunctival lesions in SS.Serum ANA,anti-SSA antibody,anti-SSB antibody,anti-SSA-52 antibody,IgG,and RF levels are significantly associated with the degree of conjunctival lesions,and can be considered as an indirect evidence of conjunctival involvement in SS.