小唾液腺活检的安全性和实用性：对单一中心进行的502例手术的回顾性分析。

Safety and usefulness of minor salivary gland biopsy: retrospective analysis of 502 procedures performed at a single center.

作者信息

Caporali Roberto, Bonacci Eleonora, Epis Oscar, Bobbio-Pallavicini Francesca, Morbini Patrizia, Montecucco Carlomaurizio

机构信息

Department of Rheumatology, University of Pavia, IRCCS San Matteo Foundation, Pavia, Italy.

出版信息

Arthritis Rheum. 2008 May 15;59(5):714-20. doi: 10.1002/art.23579.

DOI:10.1002/art.23579

PMID:18438907

Abstract

OBJECTIVE

To analyze the safety of our biopsy technique and the effectiveness of minor salivary gland biopsy (MSGB) for the diagnosis of Sjögren's syndrome (SS) and amyloidosis.

METHODS

We conducted a retrospective analysis of 452 patients with suspected SS and 50 with suspected amyloidosis and negative periumbilical fat aspiration analysis who underwent MSGB at a single center. Diagnostic evaluation for SS included Schirmer's test, unstimulated whole salivary flow, detection of antinuclear antibodies and anti-SSA/SSB, erythrocyte sedimentation rate, C-reactive protein, IgM rheumatoid factor, and serology for hepatitis C virus. For all biopsy samples, a cumulative focus score on multilevel sections was calculated. SS was diagnosed according to American-European Consensus Group (AECG) criteria. Histologic evaluation for amyloidosis was performed using Congo red staining and polarized-light microscopy. Adverse events were recorded on a questionnaire immediately after the procedure and 7 days, 14 days, and 6 months thereafter.

RESULTS

Sixty-four patients (12.7%) reported transient adverse events: 40 paresthesias lasting <7 days, 17 paresthesias lasting <14 days, 27 cases of local swelling, and 8 external hematoma. One patient has had local paresthesia for 2 years. A total of 498 (99.2%) samples provided adequate material for histologic analysis. Of 452 patients evaluated for SS, 378 were finally evaluated. Ninety-three patients (24.5%) had a cumulative focus score > or =1, and 87 (94.5%) of 93 satisfied the AECG criteria. Classification of SS was possible for 124 (32.8%) of 378 patients. In 51 (41%) of 124, MSGB was essential to reach the number of criteria needed for classification. Of 50 patients evaluated for amyloidosis, 10 (20%) had positive Congo red staining.

CONCLUSION

MSGB is a simple, safe, and reliable tool for the diagnosis of SS and amyloidosis, and therefore is suitable for more extensive application.

摘要

目的

分析我们的活检技术的安全性以及小唾液腺活检（MSGB）对干燥综合征（SS）和淀粉样变性病诊断的有效性。

方法

我们对在单一中心接受MSGB的452例疑似SS患者和50例疑似淀粉样变性病且脐周脂肪抽吸分析为阴性的患者进行了回顾性分析。对SS的诊断评估包括Schirmer试验、非刺激性全唾液流量、抗核抗体和抗SSA/SSB检测、红细胞沉降率、C反应蛋白、IgM类风湿因子以及丙型肝炎病毒血清学检查。对于所有活检样本，计算多层切片上的累积灶性评分。根据美国-欧洲共识小组（AECG）标准诊断SS。使用刚果红染色和偏振光显微镜对淀粉样变性病进行组织学评估。在操作后立即以及之后7天、14天和6个月通过问卷记录不良事件。

结果

64例患者（12.7%）报告了短暂性不良事件：40例感觉异常持续时间<7天，17例感觉异常持续时间<14天，27例局部肿胀，8例外部血肿。1例患者局部感觉异常持续了2年。总共498份（99.2%）样本提供了足够的材料用于组织学分析。在452例接受SS评估的患者中，最终有378例得到评估。93例患者（24.5%）的累积灶性评分≥1，其中93例中的87例（94.5%）符合AECG标准。378例患者中有124例（32.8%）能够进行SS分类。在124例中的51例（41%）中，MSGB对于达到分类所需的标准数量至关重要。在50例接受淀粉样变性病评估的患者中，10例（20%）刚果红染色呈阳性。