唾液腺活检对评估干燥综合症预后有重要意义
发表者：杨霖
日期：2015-02-27
浏览次数：526
评论次数：0
摘要 目的：在原发性干燥综合症中，唾液腺淋巴细胞浸润评估与预后的相互关系已经越来越受到风湿病学家的重视。淋巴细胞的浸润容易导致生发中心的形成。有文献报道淋巴细胞生发中心的形成与原发性干燥综合症所继发的非霍奇金淋巴瘤（NHL）和其他全身性疾病密切相关。本研究的目的就是研究唾液腺活检在原发性干燥综合症中的预后的价值及Ig亚型分析。
方法：本研究一共纳入了174名原发性干燥综合症患者，回顾分析他们的组织学检查结果，IgA, IgM 以及 IgG的阳性率，非霍奇金淋巴瘤的发病率以及疾病的活动指数。
结果：在发展成为非霍奇金淋巴瘤的原发性干燥综合症患者中，淋巴细胞浸润指数明显增高且大于3.而Ig的分型不能帮助临床医生来判断患者是否会发展成为非霍奇金淋巴瘤，但如果病人的活检指数>3，并且IgA阳性的浆细胞<40%或IgM阳性的浆细胞≥25%，则患者容易并发其他系统性疾病。
结论：常规唾液腺组织学评估对于原发性干燥综合症预后有重要意义，能帮助临床医师判断患者是否会发展为非霍奇金淋巴瘤
附原文：Abstract OBJECTIVES: To investigate the prognostic value of the lymphocytic focus score (LFS) and the percentages of IgA+, IgM+ and IgG+ plasma cells for disease severity of primary Sjögren syndrome (pSS).METHODS: Medical charts of 174 pSS patients were retrospectively analysed, comparing histology results (LFS and percentages of IgA+, IgM+ and IgG+ plasma cells) with disease outcomes as non-Hodgkin lymphoma (NHL) and clinical scores including cumulative EULAR (European League against Rheumatism) Sjögren syndrome disease activity index (ESSDAI) and the total number of extraglandular manifestations. RESULTS: The mean LFS was significantly higher in patients developing NHL (3.0±0.894 vs 2.25±1.086; p=0.021). The threshold of ≥3 foci has a positive predictive value of 16% for lymphoma, and a negative predictive value of 98%. Only LFS ≥3 contributed significantly and independently to NHL development in a standard multiple regression model. Ig class distribution of plasma cells did not help to identify patients developing lymphoma. Patients with LFS ≥3, ≤40% IgA+ or ≥25% IgM+ plasma cells in salivary gland biopsy specimens had significantly enhanced systemic disease.CONCLUSIONS: Routine histopathological minor salivary gland assessment has important prognostic value. The LFS might help to identify patients with an increased risk for lymphoma.
引自：Risselada AP, Kruize AA, Goldschmeding R, Lafeber FP, Bijlsma JW, van Roon JA. The prognostic value of routinely performed minor salivary gland assessments in primary Sjogren's syndrome. Ann Rheum Dis. 2014 Feb 13. doi: 10.1136/annrheumdis-2013-204634. [Epub ahead of print] 原文链接：http://www.ncbi.nlm.nih.gov/pubmed/24525912 （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）
方法：本研究一共纳入了174名原发性干燥综合症患者，回顾分析他们的组织学检查结果，IgA, IgM 以及 IgG的阳性率，非霍奇金淋巴瘤的发病率以及疾病的活动指数。
结果：在发展成为非霍奇金淋巴瘤的原发性干燥综合症患者中，淋巴细胞浸润指数明显增高且大于3.而Ig的分型不能帮助临床医生来判断患者是否会发展成为非霍奇金淋巴瘤，但如果病人的活检指数>3，并且IgA阳性的浆细胞<40%或IgM阳性的浆细胞≥25%，则患者容易并发其他系统性疾病。
结论：常规唾液腺组织学评估对于原发性干燥综合症预后有重要意义，能帮助临床医师判断患者是否会发展为非霍奇金淋巴瘤
附原文：Abstract OBJECTIVES: To investigate the prognostic value of the lymphocytic focus score (LFS) and the percentages of IgA+, IgM+ and IgG+ plasma cells for disease severity of primary Sjögren syndrome (pSS).METHODS: Medical charts of 174 pSS patients were retrospectively analysed, comparing histology results (LFS and percentages of IgA+, IgM+ and IgG+ plasma cells) with disease outcomes as non-Hodgkin lymphoma (NHL) and clinical scores including cumulative EULAR (European League against Rheumatism) Sjögren syndrome disease activity index (ESSDAI) and the total number of extraglandular manifestations. RESULTS: The mean LFS was significantly higher in patients developing NHL (3.0±0.894 vs 2.25±1.086; p=0.021). The threshold of ≥3 foci has a positive predictive value of 16% for lymphoma, and a negative predictive value of 98%. Only LFS ≥3 contributed significantly and independently to NHL development in a standard multiple regression model. Ig class distribution of plasma cells did not help to identify patients developing lymphoma. Patients with LFS ≥3, ≤40% IgA+ or ≥25% IgM+ plasma cells in salivary gland biopsy specimens had significantly enhanced systemic disease.CONCLUSIONS: Routine histopathological minor salivary gland assessment has important prognostic value. The LFS might help to identify patients with an increased risk for lymphoma.
引自：Risselada AP, Kruize AA, Goldschmeding R, Lafeber FP, Bijlsma JW, van Roon JA. The prognostic value of routinely performed minor salivary gland assessments in primary Sjogren's syndrome. Ann Rheum Dis. 2014 Feb 13. doi: 10.1136/annrheumdis-2013-204634. [Epub ahead of print] 原文链接：http://www.ncbi.nlm.nih.gov/pubmed/24525912 （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）