老年原发性干燥综合征的临床特征

Clinical feature of primary Sjogren’s syndrome in elderly

目的:探讨老年原发性干燥综合征(primary Sjogren syndrome,pSS)患者的临床特征。方法:回顾性分析上海交通大学医学院附属第九人民医院诊治的符合2012年pSS国际分类诊断标准117例患者的临床资料,根据年龄分为老年组(≥60岁,n=50)和中青年组(<60岁,n=67),对2组临床资料进行分析与比较。结果:首发症状除了口干和(或)眼干等常见表现外,老年组口腔溃疡(14.0%)较为多见;中青年组腮腺肿痛(14.9%)更为多见。老年组蛋白尿阳性及血肌酐升高的阳性率分别为10.0%、42.0%,明显高于中青年组的3.0%、6.0%(P<0.05);而老年组抗SSA抗体/抗SSB抗体及IgG阳性率分别为52.0%、34.0%,明显低于中青年组86.6%、55.2%(P<0.05);2组抗核抗体(antinuclear antibody,ANA)、补体、血常规、红细胞沉降率(erythrocyte sedimentation rate,ESR)、肝功能、肾功能等指标差异无统计学意义(均P>0.05)。老年组唾液腺超声(salivary gland ultrasound,SGUS)的阳性率低于中青年组(52.0%比73.1%,P<0.05),而唇腺活检阳性率2组比较差异无统计学意义(P>0.05)。结论:除了口干和(或)眼干是pSS最常见的临床表现,老年组较多表现为口腔溃疡;而腮腺肿痛在中青年组中更为多见。SGUS检查有望成为诊断老年pSS非侵入性辅助检查的优选方法。

Objective To explore the clinical feature of primary Sjogren’s syndrome(pSS)in the elderly.Methods Totally 117 patients were analyzed retrospectively in our hospital who met the pSS international classification diagnostic criteria in 2012.The patients were divided into the elderly group(≥60 years old,n=50)and the young and middle-aged group(<60 years old,n=67)according to their age,and the clinical data of two groups were analyzed and compared.Results Two groups both showed typical manifestations of dry mouth and(or)dry eyes,while the oral ulcers(14.0%)was more common in the elderly group,and parotid pain(14.9%)was more common in the young and middle-aged group.The positive rates of proteinuria and creatinine elevation in the elderly group were 10.0%and 42.0%,which were significantly higher(P<0.05)than those in the young and middle-aged group(3.0%and 6.0%).However,the positive rates of anti-SSA/SSB and IgG were 52.0%and 34.0%in the elderly group,obviously lower(P<0.05)than those in the young and middle-aged group(86.6%and 55.2%,respectively).There were no significant differences in ANA positivity,erythrocyte sedimentation rate(ESR),blood routine,complements,liver and kidney function between two groups.The positive rate of salivary gland ultrasound(SGUS)in the elderly group was 52.0%,which was lower than that in the middle-aged group(73.1%)(P<0.05),but the positive rate of lip gland biopsy didn’t show statistical difference between two groups.Conclusions Dry mouth and(or)dry eyes symptoms are the most common clinical manifestations in the patients with pSS.More cases in the elderly group have oral ulcers,while more patients in young and middle-aged group show the symptoms of parotid swelling and pain.Ultrasonography of salivary gland is expected to be the preferred method for the diagnosis of non-invasive auxiliary examination in elderly patients with pSS.