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目的:在我国患者中重新评价原发性干燥综合征(PSS)眼科诊断试验的临床价值。方法:用Schirmer试验、BUT试验和角膜荧光素活体染色试验。在112例PSS患者和185例对照者中,评估上述试验的敏感度和特异度及其主要影响因素。结果:Schirmer、角膜荧光素活体染色和BUT试验的特异度分别为43.8％、93.5％和31.4％,敏感度分别为91.7％、50.0％和87.5％。统计分析显示Schirmer试验和BUT试验的特异度与年龄呈负相关(P<0.001),而敏感度与年龄呈正相关(P<0.05)。在55岁以上的患者,除角膜荧光素活体染色试验外各项试验的诊断价值有限。按目前我国诊断KCS的标准,上述三项试验中两项或两项以上异常,诊断的敏感度和特异度分别为84.8％和49.7％。结论:有持续性眼干患者并Schirmer试验(<5mm/5min)和(或)角膜荧光素活体染色试验阳性可明显提高临床诊断的敏感度(79.5％)和特异度(97.8％)(P<0.001)。
OBJECTIVE: To re-evaluate the clinical value of ophthalmic diagnostic tests in patients with primary Sjogren’s Syndrome (PSS) in our patients. Methods: Schirmer test, BUT test and corneal fluorescein in vivo staining test. In 112 PSS patients and 185 controls, the sensitivity and specificity of these tests and their major influencing factors were evaluated. Results: The specificities of Schirmer, corneal fluorescein staining and BUT test were 43.8%, 93.5% and 31.4%, respectively, with sensitivities of 91.7%, 50.0% and 87.5%, respectively. Statistical analysis showed that the specificity of Schirmer test and BUT test was negatively correlated with age (P <0.001), while the sensitivity was positively correlated with age (P <0.05). In patients over the age of 55, in addition to corneal fluorescein in vivo staining test of each test is of limited diagnostic value. According to the current standard of diagnosis of KCS in our country, the sensitivity and specificity of diagnosis of two or more of the above three tests were 84.8% and 49.7% respectively. CONCLUSIONS: The positive rate of clinical diagnosis (79.5%) and specificity (97.8%) in patients with persistent dry eye with Schirmer test (<5mm / 5min) and / or positive corneal fluorescein staining (P < 0.001).