腹壁脂肪与唇腺活检联合诊断轻链型淀粉样变性的价值

The value of abdominal fat aspiration and labial salivary gland biopsy in diagnosing immunoglobulin light chain amyloidosis

目的:分析常用腹壁脂肪活检及唇腺活检在诊断轻链型淀粉样变性(AL)中的应用,探讨这2种微创活检方法在不同器官(心脏、肾脏)累及患者中的应用价值。方法:回顾性分析2017年3月至2018年8月59例AL患者的临床资料,分析心脏、肾脏累及情况及腹壁脂肪和唇腺活检的结果。结果:59例患者中,心脏累及45例、肾脏累及27例。腹壁脂肪活检阳性率为68.5%(37/54),唇腺活检阳性率为62.8%(27/43),腹壁脂肪联合唇腺活检阳性率为85.4%(35/41)。心脏累及患者唇腺活检阳性率高于心脏未累及患者(71.9%vs 30.0%,P=0.027),两者腹壁脂肪活检阳性率差异无统计学意义。2种微创活检阳性率在肾脏累及患者与肾脏未累及患者间差异均无统计学意义。结论:联合应用腹壁脂肪及唇腺活检可以提高系统性AL的确诊率;心脏累及患者对唇腺活检更敏感,建议临床对怀疑AL心脏累及患者进行唇腺活检。

Objective:To evaluate the value of abdominal fat aspiration and labial salivary gland biopsy in diagnosing immunoglobulin light chain (AL) amyloidosis with different organ involvement. Methods:A total of 59 patients diagnosed as AL amyloidosis from March 2017 to August 2018 were included. The cardiac and renal involvement, and results of abdominal fat aspiration and labial salivary gland biopsy were analyzed. Results:A total of 59 patients were selected, cardiac involvement and renal involvement were confirmed in 45 and 27 patients respectively. The positive rate of abdominal fat aspiration and labial salivary gland biopsy was 68.5%(37/54) and 62.8%(27/43) respectively, and 85.4%(35/41) for two methods combined in AL amyloidosis patients. The positive rate of labial salivary gland biopsy was significantly higher in patients with cardiac involvement than those who without (71.9% vs 30.0%, P =0.027), but no significant difference for abdominal fat aspiration was found between the two groups. The positive rates of these two methods had no statistically significant difference in patients with or without renal involvement. Conclusions:The combination of abdominal fat aspiration and labial salivary gland biopsy could increase the positive rates for AL amyloidosis;the cardiac involved patients are sensitive to the labial salivary gland biopsy, which should be emphasized in these patients.