摘要
目的探讨免疫球蛋白(Ig)G4相关性涎腺炎的临床特点,分析与SS的不同之处及IgG4相关性涎腺炎的治疗方法及预后,便于临床医生早期诊断并给予合理的诊疗方案。方法收集2015—2017年就诊于新疆医科大学第一附属医院的12例IgG4相关性涎腺炎及78例SS患者,回顾性分析IgG4相关性涎腺炎的临床表现、实验室检查、病理学检查、影像学检查、药物治疗及药物治疗效果,与SS进行比较,应用SPSS 19.0软件对计数资料采用χ^(2)检验或Fisher确切概率法进行统计学分析。结果IgG4相关性涎腺炎是以双侧一对或一对以上涎腺、泪腺持续肿大、血清IgG4水平升高为主要特点,在病理及影像学上均有特点。与SS患者相比较,腺体肿大(12/12和18/78,χ^(2)=24.339,P<0.01),口干眼干症状(9/12和78/78,P<0.01),血清学检查阳性:IgG4(12/12和0/78,χ^(2)=81.554,P<0.01),ANA(1/11和78/78,χ^(2)=71.030,P<0.01),抗SSA抗体(0/9和68/78,χ^(2)=31.001,P<0.01),抗SSB抗体(0/9和36/78,χ^(2)=5.311,P=0.021),抗Ro-52抗体(0/9和70/78,χ^(2)=35.824,P<0.01),病理学检查:IgG4阳性浆细胞浸润(12/12和0/78,χ^(2)=81.554,P<0.01)及激素治疗疗效(6/6和0/34,P<0.01),差异均有统计学意义(P<0.05)。IgG4相关性涎腺炎对激素及利妥昔单抗体使用效果较好,SS对激素使用效果欠佳,并出现病情反复。结论IgG4相关性涎腺炎有自身的特点,与SS有明显不同,在临床上可行鉴别诊断,尽早发现,并制定合理的治疗方案。
Objective To explore the clinical characteristics of Immunoglobulin G4 (IgG4) related sialoadenitis, to analyze the difference between the IgG4 related sialoadenitis and Sjogren′ syndrome (SS) and to summarize the treatment method and prognosis of the disease, so as to help clinical diagnosis and appro-priate treatment. Methods According to inclusion criteria and exclusione criteria, we collected 12 cases of IgG4 related sialoadenitis patients and 78 cases of SS patients from the First Affiliated Hospital of Xinjiang Medical University from 2015-2017. The clinical manifestations, laboratory test, pathological examinations, imaging examinations and the effects of treatment of IgG4 related sialoadenitis were retrospectively anal-yzed. Several aspects of the examination were compared with SS. The count data was analyzed by chi-square test or Fisher exact probality using Statistical program for social sciences (SPSS) 19.0 software. Results Character-istics of IgG4 related sialoadenitis was that one or more pairs of salivary glands and lacimal glands were enlar-ged with increasing serum IgG4 levels and IgG4+ plasma cell infiltration. Compared with SS, sialoadenitis enl-argement (12/12 vs 18/78,χ^(2)=24.339, P<0.01), dry eyes and mouth (9/12 vs 78/78, P<0.01), serum IgG4 (12/12 vs 0/78,χ^(2)=81.554, P<0.01), antinuclear antibodies (1/11 vs 78/78,χ^(2)=71.030, P<0.01), anti-SSA antibody (0/9 vs 68/78,χ^(2)=31.001, P<0.01), anti-SSB antibody (0/9 vs 36/78,χ^(2)=5.311, P=0.021), anti-Ro-52 antibody (0/9 vs 70/78,χ^(2)=35.824, P<0.01), infiltration of IgG4 positive plasma cell (12/12 vs 0/78,χ^(2)=81.554, P<0.01), therapeutic efficacy of glucocorticoid (6/6 vs 0/34, P<0.01) was statistically significant. Conclusion IgG4 related sialoadenitis has remarkable characteristics in clinical manifestations, serology, pathology and imaging examinations. Although IgG4 related sialoadenitis and SS have many similarities, we still need to diagnose the disease as early as possible and set up a reasonable treatment plan for patients.
作者
李晓杰
邵博
刘慧
龚忠诚
Li Xiaojie;Shao Bo;Liu Hui;Gong Zhongcheng(Oral and Maxillofacial Surgical Ward Medical Center, the Affiliated Stomatological Hospital of Soochow University, Suzhou Stomatological Hospital, Jiangsu 215000, China;Oral and Maxillofacial Tumor Surgical Ward Medical Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2019年第9期599-604,I0002,共7页
Chinese Journal of Rheumatology
基金
国家自然科学基金(81760191).
