原发性干燥综合征舌苔剥脱患者的临床特点

Clinical Characteristics of Geographic Tongue in Patients with Primary Sj?gren’s Syndrome

目的:分析原发性干燥综合征(pSS)舌苔剥脱患者的临床特点。方法:纳入2018年12月至2021年10月于中日友好医院就诊的pSS患者,根据舌苔剥脱与否及剥脱严重程度进行分组,Phi相关、卡方检验和Mann-Whitney秩和检验分析舌苔剥脱患者的临床特点。结果:共纳入pSS患者182例,其中舌苔剥脱75例(41.2%),无剥脱苔107例(58.8%),其中部分剥脱较全剥更常见,剥脱部位以舌前半部最多见。舌苔重度剥脱患者数量多于轻中度剥脱者。与舌苔无剥脱患者相比,舌苔剥脱患者更常见舌体裂纹(92.0%/41.1%,χ^(2)=48.491,P<0.05)、舌色红/绛(48.0%/23.3%,χ^(2)=12.009,P<0.05)、阴虚证(100.0%/43.9%,χ^(2)=62.739,P<0.05)、气虚证(94.7%/50.5%,χ^(2)=40.046,P<0.05),少见痰湿证(33.3%/72.0%,χ^(2)=26.709,P<0.05),存在高球蛋白血症(89.3%/65.4%,χ^(2)=13.547,P<0.01)、ANA≥1∶160(78.1%/57.3%,χ^(2)=8.227,P<0.01)及类风湿因子(RF)阳性(51.4%/36.5%,χ^(2)=3.877,P<0.05)的比例更高;与舌苔轻度剥脱患者比较,中重度剥脱患者存在高球蛋白血症(98.1%/68.2%,χ^(2)=14.617,P<0.01)、抗着丝点蛋白-B(CENP-B)抗体阳性(26.0%/4.8%,χ^(2)=4.214,P<0.05)及C3降低(26.4%/4.5%,χ^(2)=4.647,P<0.05)的比例更高。舌苔剥脱与舌体裂纹(φ=0.531)、阴虚证(φ=0.587)、气虚证(φ=0.469)呈正相关,与痰湿证呈负相关(φ=-0.447),与舌色的相关性弱(φ<0.4)。舌苔剥脱与否及不同剥脱程度患者间疾病活动指数差异无统计学意义。结论:超过40%的pSS患者存在舌苔剥脱,常伴舌体裂纹,与阴虚、气虚证呈正相关,与痰湿证呈负相关,提示治疗应以益气养阴为主;与舌苔无剥脱患者相比,舌苔剥脱患者部分免疫指标阳性率更高,值得进一步研究。

Objective:To analyze the clinical characteristics of geographic tongue in patients with primary Sj?gren’s syndrome(pSS).Method:Patients with pSS treated in the China-Japan Friendship Hospital from December 2018 to October 2021 were enrolled and divided into different groups according to the presence of geographic tongue or the severity.Phi correlation analysis,Chi-square test,and Mann-Whitney test were used to analyze the clinical characteristics of patients with geographic tongue.Result:A total of 182 pSS patients were included in this study,including 75(41.2%)patients with geographic tongue and 107(58.8%)without geographic tongue.Partial exfoliation was more common than total exfoliation,and the anterior part of the tongue was the most common exfoliation site.The number of patients with severe geographic tongue was more than those with mild-to-moderate geographic tongue.Compared with pSS patients without geographic tongue,those with geographic tongue were more common in fissured tongue(92.0%/41.1%,χ^(2)=48.491,P<0.05),red or crimson tongue(48.0%/23.3%,χ^(2)=12.009,P<0.05),Yin deficiency syndrome(100.0%/43.9%,χ^(2)=62.739,P<0.05),and Qi deficiency syndrome(94.7%∶50.5%,χ^(2)=40.046,P<0.05),less common in phlegm-dampness syndrome(33.3%/72.0%,χ^(2)=26.709,P<0.05),and showed higher proportions in hyperglobulinemia(89.3%/65.4%,χ^(2)=13.547,P<0.01),ANA≥1∶160(78.1%/57.3%,χ^(2)=8.227,P<0.01),and positive RF(51.4%/36.5%,χ^(2)=3.877,P<0.05).Compared with pSS patients with mild geographic tongue,pSS patients with moderate-tosevere geographic tongue had higher proportions in hyperglobulinemia(98.1%/68.2%,χ^(2)=14.617,P<0.01),positive anti-CENP-B(26.0%/4.8%,χ^(2)=4.214,P<0.05),and reduced complement 3(26.4%/4.5%,χ^(2)=4.647,P<0.05).The geographic tongue was positively associated with fissured tongue(φ=0.531),Yin deficiency syndrome(φ=0.587),and Qi deficiency syndrome(φ=0.469),negatively associated with phlegm-dampness syndrome(φ=-0.447),and weakly associated with tongue color(φ<0.4).There was no statistical difference in the disease activity index between patients with or without geographic tongue and severity.Conclusion:More than 40%of pSS patients had geographic tongue accompanied by fissured tongue.Geographic tongue is positively associated with Yin deficiency syndrome and Qi deficiency syndrome,and negatively associated with phlegm-dampness syndrome,indicating that treatment should be based on tonifying Qi and nourishing Yin.Compared with pSS patients without geographic tongue,those with geographic tongue may have higher positive rate of some immune indicators,which deserves further exploration.