结节型舍格伦综合征与恶性淋巴瘤关系初探

Preliminary study of the relationship between tumor like Sjogren＇s syndrome and malignant lymphoma

目的探讨结节型舍格伦综合征（tumor like Sjogren’s syndrome，TLSS）与非TESS（non-TLSS，NTLSS）患者临床、实验室特征及淋巴瘤的发生情况，以期为临床预测舍格伦综合征尤其是TESS患者发生恶性淋巴瘤转化提供依据。方法收集1998年1月至2010年1月就诊于北京大学口腔医学院·口腔医院并诊断为原发性舍格伦综合征或TESS的患者199例，回顾性研究199例患者临床及实验室资料，根据有无腺体肿块将患者分为TLSS组（25例）及NTLSS组（174例），分析临床及实验室指标的差异并行统计学分析。结果25例TLSS患者中23例为腮腺肿块，2例为颌下腺肿块；TLSS患者在腮腺造影阳性率（P=0．018）、1球蛋白异常水平（P=0．014）、类风湿因子异常水平（P=0．001）、唇腺生发中心样结构形成（P=0．014）、抗SSA抗体及抗SSB抗体双阳性率（P〈0．001）方面与NTLSS患者差异均有统计学意义；25例TLSS患者中3例发生淋巴瘤，占入选病例总数的1．5％（3／199），占TLSS患者的12％（3／25），3例淋巴瘤包括腹股沟区弥漫性大B细胞淋巴瘤1例及黏膜相关淋巴组织淋巴瘤2例；NTLSS患者无淋巴瘤发生。结论TESS与NTLSS患者在临床及实验室特征方面存在差异，TLSS患者更易出现淋巴瘤。

Objective To investigate the clinical and laboratory characteristics of tumor like Sjtigren＇s syndrome（TLSS） patients and non-tumor like Sjtogren＇s syndrome（NTLSS） and the incidence of lymphoma in patients of Sjtigren＇s syndrome（SS）. Methods A retrospective analysis was carried out in 199 primary SS（ including TLSS） patients who were recruited in Peking University School and Hospital of Stomatology from 1998 to 2010. Clinical and laboratory information were collected. The patients were divided into two groups ： TLSS （ n = 25 ） and NTLSS （ n = 174）. Clinical and laboratory characteristics were compared between these two groups by a statistical analysis. Results Of the 25 TLSS patients, 23 had enlargements of parotid glands and 2 had enlargements of submandibular glands. There were significant differences of salivary scintigraphy appearance （ P = O. 018 ）, hypergammaglobulinemia （ P = 0. 014 ）, rheumatoid factor positive rate（P = 0. 001 ）, formation of the ectopic germinal centers （P = 0. 014）, double positive rate of anti-SSA antibody and anti-SSB antibody（ P 〈 0. 001 ） between the TLSS and NTLSS patients. Among the 25 TLSS patients, 3 developed lymphomas, accounting for 1.5% （3/199） of the total 199 patients and 12% （3/25） of the TLSS patients. Lymphoma subtypes included one diffused large B-cell lymphoma and two mucosa-associated lymphoid tissue lymphoma. There was no lymphoma detected in NTLSS patients. Conclusions There are clinical and laboratory differences between TLSS and NTLSS patients with a more tendency to develop lymphomas in TLSS patients.