van Gameren Ingrid I, Hazenberg Bouke P C, Bijzet Johan, van Rijswijk Martin H
University Medical Center, University of Groningen, Groningen, The Netherlands.
Arthritis Rheum. 2006 Jun;54(6):2015-21. doi: 10.1002/art.21902.
Aspiration of subcutaneous abdominal fat is a simple and fast method for detecting systemic amyloidosis; however, the sensitivity of this approach remains undetermined. The aim of this study was to assess the accuracy of fat tissue aspiration for detecting systemic amyloidosis and the utility of this method in clinical practice.
All consecutive patients with established and suspected systemic amyloidosis who attended our tertiary referral hospital between 1994 and 2004 underwent aspiration of subcutaneous abdominal fat. Congo red-stained tissue was assessed quickly in a single smear in a routine manner by a single observer, and was also assessed thoroughly in 3 smears by 2 independent observers.
One hundred twenty patients with established systemic amyloidosis were studied (38 with AA amyloidosis, 70 with AL amyloidosis, and 12 with ATTR amyloidosis). Routine (quick) assessment was associated with a sensitivity of 80% (95% confidence interval [95% CI] 72-87%). Sensitivity increased to 93% (95% CI 87-97%) when 3 smears were thoroughly examined. The specificity of fat aspiration in 45 control subjects was 100% (95% CI 92-100%). One hundred sixty-two patients for whom there was a clinical suspicion of systemic amyloidosis were screened for amyloidosis by fat tissue aspiration and biopsy of at least 1 other tissue. In 69 (43%) of these 162 patients, a diagnosis of amyloidosis was established, and in 66 (96%) of these patients, the results of fat tissue aspiration were positive. The clinical utility of fat tissue aspiration was greater than that of biopsy of the rectum.
Subcutaneous abdominal fat aspiration is the preferred method for detecting systemic amyloidosis, with sensitivity of 80% associated with use of a routine approach. The use of a thorough assessment (3 fat smears, 2 observers) increased sensitivity to >90%. If the results of fat tissue aspiration are negative, the additional value of a subsequent biopsy of the rectum is negligible.
抽吸腹部皮下脂肪是检测系统性淀粉样变的一种简单快速的方法；然而，这种方法的敏感性仍未确定。本研究的目的是评估脂肪组织抽吸检测系统性淀粉样变的准确性以及该方法在临床实践中的实用性。
1994年至2004年间在我们的三级转诊医院就诊的所有确诊和疑似系统性淀粉样变的连续患者均接受了腹部皮下脂肪抽吸。刚果红染色的组织由一名观察者以常规方式在单张涂片上快速评估，也由两名独立观察者在3张涂片上进行全面评估。
对120例确诊系统性淀粉样变的患者进行了研究（38例为AA型淀粉样变，70例为AL型淀粉样变，12例为ATTR型淀粉样变）。常规（快速）评估的敏感性为80%（95%置信区间[95%CI]72 - 87%）。当对3张涂片进行全面检查时，敏感性提高到93%（95%CI 87 - 97%）。45例对照受试者脂肪抽吸的特异性为100%（95%CI 92 - 100%）。对162例临床怀疑系统性淀粉样变的患者进行了脂肪组织抽吸和至少1个其他组织的活检以筛查淀粉样变。在这162例患者中的69例（43%）中确诊为淀粉样变，其中66例（96%）脂肪组织抽吸结果为阳性。脂肪组织抽吸的临床实用性大于直肠活检。
腹部皮下脂肪抽吸是检测系统性淀粉样变的首选方法，常规方法的敏感性为80%。采用全面评估（3张脂肪涂片，2名观察者）可将敏感性提高到>90%。如果脂肪组织抽吸结果为阴性，随后直肠活检的附加价值可忽略不计。
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