老年原发性干燥综合征的早期诊断

Early diagnosis of elderly patients with primary Sjgren syndrome

目的 提高对老年原发性干燥综合征的认识和早期诊断率。方法 对 8例延误诊断的老年原发性干燥综合征的临床资料进行回顾性分析。结果 8例患者确诊前病程最短 2 .5年 ,最长 8年 ,均为延误诊断病例。主要表现为 :口眼干 ( 10 0 % )、关节痛 ( 10 0 % )、龋齿 ( 6 2 .5 % )、肌肉痛 ( 37.5 % )、夜尿多 ( 37.5 % )、腮腺肿大 ( 12 .5 % ) ,以及反复咳嗽、咳痰、进行性气喘加重、消化不良、下肢紫癜样皮疹、网状青斑、低钾性瘫痪等。主要相关检查发现 :ANA( + ) ( 10 0 % )均为斑点型、抗SSA( + ) ( 10 0 % )、抗SSB( + ) ( 6 2 .5 % ) ,以及γ 球蛋白增高、RF( + )、尿pH升高等。口腔科和眼科检查阳性率 10 0 %。结论 提高老年原发性干燥综合征的早期诊断率的关键在于 :( 1)加强各科医生对干燥综合征的了解与认识 ;( 2 )口腔科与眼科应开展口、眼干燥综合征的相关检查项目 。

Objective To enhance the understanding and early diagnosis rate of elderly patients with primary Sjgren Syndrome (pSS).Methods The clinical data of eight elderly patients with pSS were analyzed retrospectively. Results The courses from initiation of clinical symptoms to definite diagnosis were 2.5～8 years. They were all delayed in diagnosis. The major clinical manifestations were: dryness of mouth/eye (100%),arthralgia(100%) decayed tooth (37.5%),and muscular pain (37.5%),urinary amount increase in night (37.5%),parotid swollen (12.5%),coughing, coughing up phlegm repeatedly, progressive panting, dyspepsia, hyperglobulinemia purpura in lower limbs, maculopapular net, and hypokalaemia paralysis etc. ANA(+),anti SSA and/ anti SSB (+),hyperglobulinemia, RF (+), elevated pH of urine. Positive rate of oral and eyes findings was 100%.Conclusion The key to diagnose pSS is (1) to let clinical doctors enhance understanding for pSS and (2)the examination items related to dryness of mouth and eyes should be established, and the detection of ANA and anti ENA is helpful to early diagnosis.