唇腺活检对诊断干燥综合征的意义

LABIAL SALIVARY GLAND BIOPSY IN THE DIAGNOSIS OF SJOGREN'S SYNDROME

对１９６例可疑的干燥综合征（ＳＳ），患者作了唇腺活检（ＬＳＧ－Ｂ）和Ｓｃｈｉｒｍｅｒ试验、角膜荧光染色和ＳＳ－Ａ／ｓＳ－Ｂ抗体等免疫学检查。１９６例中１１７例ＬＳＧ－Ｂ≥２个灶／４ｍｍ￣２，其中９２例同时有干燥性角膜结膜炎（ＫＣＳ），符合Ｔａｌａｌ的ＳＳ诊断标准。余２５例ＬＳＧ－Ｂ阳性而不伴有ＫＣＳ者，１６例符合继发性ＳＳ（２°ＳＳ），９例有ＳＳ的临床特征表现和ＳＳ一Ａ／ＳＳ－Ｂ阳性而不能排除ＳＳ。此外ＬＳＧ－Ｂ（－）而有ＫＣＳ阳性者１１例均符合原发性ＳＳ（１°ＳＳ）或２°ＳＳ。本组１２８例ＳＳ中ＬＳＧ－Ｂ的阳性率为９１％。我们还发现２°ＳＳ在ＬＳＧ－Ｂ中的灶性涎腺炎严重程度明显轻于１°ＳＳ，而在１°ＳＳ中灶性涎腺炎的严重程度与系统累及呈正相关。

abial salivary gland biopsy(LSG-B)along with Schirmer test and kerato-conjunctival staining with fluorescein dye was performed in 196 patients with suspected Sjogren's syndrome(SS). of the 196patients, 117 were found to have 2 or more lymphocytic focus scores(LFS/4mm￣2) on their LSG-Bspecimens.92 of them having keratoconjunctivitis sicca(KCS) as well met the diagnostic criteria of SS.Among the cases (25) without KCS, 16 with another CTD were diagnosed as secondary SS. 9 cases wereclassified as probable primary SS in this study because they had clinical manifestations of SS. Of the 11cases with KCS only,6 with another CTD were diagnosed as secondary SS; 5 befitted primary SS forabnormal findings on sialography. We also found that lymphocytic infiltration in LSG-Bwas muchmore severe in primary SS than in secondary SS; this could be attributed to the use of immunotherapyfor the accompaning CTD in secondary SS. There was good association in our study between the severi-ty of lymphocytic infiltration and systemic involvement.