219例唇腺活检患者病理特点与病情相关性分析  

Correlations between histopathologic features of labial glands and disease conditions among 219 patients undergoing labial gland biopsy

作　　者：李红霞 周雅馨 杜望磊 王鹏宇 蔡鑫 符向辉 张葵 朱平 吴振彪 LI Hongxia;ZHOU Yaxin;DU Wanglei;WANG Pengyu;CAI Xin;FU Xianghui;ZHANG Kui;ZHU Ping;WU Zhenbiao(Department of Rheumatology and Immunology,Air Force Medical Center,Beijing 100142,China;不详)

机构地区：[1]空军特色医学中心风湿免疫科,北京100142 [2]空军军医大学第一附属医院临床免疫科,西安710032

出　　处：《空军医学杂志》2021年第5期424-428,共5页Medical Journal of Air Force

摘　　要：目的分析唇腺病理在干燥综合征(sjögren's syndrome,SS)和非SS患者的病理特点,为SS的诊断和鉴别诊断提供病理资料。方法收集2020年6月—2021年2月在空军军医大学第一附属医院临床免疫科门诊行唇腺活检219例患者的临床资料,分析病理特点与诊断及病情的相关性。结果原发性干燥综合征(primary sjögren's syndrome,pSS)117例,继发性干燥综合征(secondary sjögren's syndrome,sSS)17例,非SS 85例。pSS患者中,唇腺病理灶性指数(focus score,FS)≥1占46.2%,0<FS<1占26.5%,正常和慢性涎腺炎的分别为15.4%和12%;17例sSS患者唇腺病理均有异常,FS≥1的占38.5%;而非SS患者中0<FS<1占24.7%,正常和慢性涎腺炎的分别为30.6%和44.7%。pSS和非SS患者病理0<FS<1差异无统计学意义,pSS慢性涎腺炎和正常者均低于非SS。Schirmer试验和未刺激唾液流率pSS组阳性率与sS组S和非SS组比较,差异无统计学意义。非SS患者85例,27例为结缔组织病(connective tissue disease,CTD)和58例为非CTD,慢性涎腺炎在2组间比较差异无统计学意义;病理正常的非CTD组多于CTD组,而0<FS<1的较CTD组明显减少,差异有统计学意义。CTD组中抗干燥综合征A(anti-sjögren's syndrome A,SSA)、抗干燥综合征B(anti-Sjögren's syndrome B,SSB)阴性而抗Ro-52阳性17例患者中16例(94.1%)唇腺病理为0<FS<1或慢性涎腺炎。结论pSS唇腺病理中0<FS<1、慢性涎腺炎和正常病理常见,这些病理在非SS患者也很常见;Schirmer试验和未刺激唾液流率对pSS诊断的特异性差,pSS诊断需要结合临床表现、自身抗体及病理特点综合判断。抗Ro-52单独阳性可能与涎腺炎相关。Objective To analyze the histopathologic features of labial glands of patients with Sjögren's syndrome(SS)and non-SS patients in order to provide pathological data for diagnosis and differential diagnosis of SS.Methods Two hundred and nineteen patients who underwent labial gland biopsy were enrolled from the Department of Clinical Immunology,Xijing Hospital,between June 2020 and February 2021.Their clinical,laboratory and pathological data was collected,and the association between pathology and diagnosis was analyzed.Results One hundred and seventeen pSS patients,17 sSS patients and 85 non-SS patients were involved.Among the pSS patients,cases of labial gland pathologies of FS≥1,0<FS<1,chronic sialadenitis and normal values accounted for 46.2%,26.5%,12%and 15.4%respectively.For the sSS patients,pathology was abnormal and FS≥1 in 38.5%of the patients.Among the non-SS patients,the cases of 0<FS<1,chronic sialadenitis and normal values made up 24.7%,44.7%and 30.6%respectively.In pSS patients,the incidence of 0<FS<1 was similar to that of non-SS ones,but the incidence of chronic sialadenitis and normal values was significantly lower.The positive rate of Schirmer test and unstimulated salivary fluid in the pSS patients was 71.6%and 59.7%respectively,which was not significantly different between the pSS and non-SS patients.The 85 non-SS patients included 27 CTD and 58 non-CTD patients.Normal pathology in non-CTD patients was more common than in CTD patients,but there were much fewer cases of 0<FS<1 and there was no difference in the incidence of chronic sialadenitis between the two groups.The pathology of 94.1%(16/17)of the patients who were positive for anti-Ro-52 but negative for anti-SSA and anti-SSB was abnormal,including 0<FS<1 or chronic sialadenitis.Conclusion In the labial gland pathologies of pSS,cases with 0<FS<1,chronic sialadenitis and normal values are common,and the specificities of Schirmer test and unstimulated salivary fluid are poor.Therefore,pSS diagnosis needs to combine clinical manifestations

关 键 词：唇腺活检 干燥综合征 病理 结缔组织病 

分 类 号：R593[医药卫生—内科学] R602[医药卫生—临床医学]