系统性淀粉样变患者诊断性活检部位的选择

Selection of Biopsy Site for Patients with Systematic Amyloidosis

目的探讨不同的组织器官活检诊断系统性淀粉样变的阳性率。方法回顾性分析2009年1月至2015年6月北京协和医院确诊的194例系统性淀粉样变患者的临床资料和活检结果。结果受累器官活检是阳性率最高的活检部位,其中肾脏、心脏和肝脏的阳性率分别为97.4%、95.0%和87.5%。而在微创性活检部位中,阳性率由高到低分别为舌体75%、齿龈57%、腹壁脂肪57%、直肠16%和骨髓8%。联合舌体与腹壁脂肪活检可使阳性率提高到93.1%。结论受累器官活检仍然是阳性率最高的活检方式,联合多部位的微创活检可能达到与受累器官活检相近的阳性率,且更为方便安全。

Objective To evaluate the sensitivities of various biopsy methods for the diagnosis of systematic amyloidosis（ SA）. Methods The clinical data and biopsy results of 194 SA patients who were treated in Peking Union Medical College Hospital from January 2009 to June 2015 were retrospectively analyzed. Results The highest sensitivity was achieved by biopsy of affected organs, with renal biopsy 97. 4%, heart biopsy95. 0% and liver biopsy 87. 5%. Among non-invasive biopsy methods,tongue biopsy was found to be 75% sensitive,followed by gingiva biopsy at 57%,abdominal fat pad aspiration at 57%,rectum biopsy at 16%,and bone marrow examination at 8%. Combination of tongue and abdominal fat pad biopsy yielded a detection rate of93. 1%. Conclusions Biopsy of the involved organ has the highest sensitivity. However,combination of multiple non-invasive biopsy methods may has sensitivity comparable to organ biopsy and is safer and more convenient.