舌组织活检在系统性淀粉样变性诊断中的意义  

Significance of tongue tissue biopsy in the diagnosis of systemic amyloidosis

作　　者：徐偲 张紫妍 田颖[3] XU Si;ZHANG Ziyan;TIAN Ying(Department of Stomatology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020;Department of Stomatology,Beijing Yujiawu Community Healthcare Center,Beijing 101100;Department of Hematology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院口腔科,北京100020 [2]北京市于家务卫生社区服务中心口腔科,北京101100 [3]首都医科大学附属北京朝阳医院血液科,北京100020

出　　处：《临床与病理杂志》2024年第4期524-531,共8页Journal of Clinical and Pathological Research

基　　金：首都医科大学本科生科研创新项目(XSKY2019184)。

摘　　要：目的:淀粉样变性是一种罕见的异质性疾病。中位生存期因累及脏器的不同而差异显著,诊断需要高度依赖病理,但是因为重要脏器活检困难,皮肤活检及骨髓活检诊断的阳性率较低,因此需要一种易于实施的、创伤较小的诊断方法,这对于明确诊断有重要意义。方法:回顾性分析2017至2023年就诊于首都医科大学附属北京朝阳医院,因怀疑系统性淀粉样变性累及其他器官行舌活检的36例患者的病历,收集其人口学信息、实验室检查结果、其他辅助检查结果及病理结果。统计并分析性别、年龄、病程、化疗次数、舌临床检查情况在怀疑为系统性淀粉样变性患者中的差异。计算舌活检总阳性率,应用Spearman相关性分析检验心肌酶异常、肾功能异常、血液轻链蛋白异常、超声心动图结果阳性、心脏磁共振结果阳性、舌质地(韧)、舌活动情况(受限)、舌周缘存在齿痕、肌酸激酶(血)、脑利尿钠肽(brain natriuretic peptide,BNP)(血)值、电解质异常、β2微球蛋白(血)、骨髓细胞学浆细胞比例与舌活检结果的相关性。计算脂肪活检的阳性率并与舌活检结果、超声心动图结果进行比较。应用Logistic逐步回归分析舌活检结果的相关因素。结果:在36例患者中,多发性骨髓瘤(multiple myeloma,MM)、原发性轻链型淀粉样变(primary light chain amyloidosis,pAL)、有临床意义的单克隆免疫球蛋白血症(monoclonal gammopathies of clinical significance,MGCS)的患者分别为19、9、8例。3种疾病患者的性别构成、年龄、病程和化疗次数差异均无统计学意义(均P>0.05)。舌质地(韧)、舌活动情况(受限)在3种疾病中的差异有统计学意义(P<0.05),而舌周缘存在齿痕在3种疾病中的差异无统计学意义(P>0.05)。舌活检总阳性率52.78%,Spearman相关性分析结果显示心肌酶异常(r=0.35,P<0.05)、超声心动图结果阳性(r=0.51,P<0.05)、舌质地(韧)(r=0.44,P<0.05)�Objective:Amyloidosis is a rare heterogeneous disease.The median survival time varies significantly due to the involvement of different organs.The diagnosis relies heavily on pathology,but due to the difficulty of biopsy in important organs,the positive rate of diagnosis by skin biopsy and bone marrow biopsy is low.Therefore,a readily implementable and less invasive diagnostic method is needed,which is of great significance for clarifying the diagnosis.Methods:A retrospective analysis was conducted on the clinical data of 36 patients suspected of having systemic amyloidosis affecting other organs who underwent tongue biopsy at Beijing Chaoyang Hospital affiliated to Capital Medical University from 2017 to 2023.Demographic information,laboratory test results,other auxiliary examination results,and pathological results of the patients were collected.The differences in gender,age,disease duration,number of chemotherapy sessions,and tongue clinical examination among patients suspected of having systemic amyloidosis were statistically analyzed.The total positive rate of tongue biopsy was calculated,and the correlation between myocardial enzyme abnormalities,renal function abnormalities,blood light chain protein abnormalities,positive echocardiography results,positive cardiac magnetic resonance imaging results,tongue texture(tough),tongue movement(restricted),presence of tooth marks around the tongue,creatine kinase(blood),brain natriuretic peptide(BNP)(blood)levels,electrolyte abnormalities,β2-microglobulin(blood),and the proportion of plasma cells in bone marrow cytology with tongue biopsy results was tested using Spearman correlation analysis.The positive rate of fat biopsy was calculated and compared with tongue biopsy results and echocardiographic results.Logistic stepwise regression was used to analyze the related factors of tongue biopsy results.Results:Among the 36 patients,there were 19 cases of multiple myeloma(MM),9 cases of primary light chain amyloidosis(pAL),and 8 cases of monoclonal gammopathies of clin

关 键 词：舌组织活检 系统性淀粉样变性 诊断意义 

分 类 号：R781.57[医药卫生—口腔医学]