Bookman Arthur A M, Shen Hua, Cook Richard J, Bailey Denis, McComb R John, Rutka John A, Slomovic Allan R, Caffery Barbara
University of Toronto, Toronto, Ontario, Canada.
Arthritis Rheum. 2011 Jul;63(7):2014-20. doi: 10.1002/art.30295.
To determine which measure of the salivary flow rate, stimulated or unstimulated, is most strongly associated with pathologic changes in minor salivary gland (MSG) biopsy specimens, and to explore the correlation of salivary flow with oral surface damage, disease duration, and symptom severity in patients with primary Sjögren's syndrome (SS).
In all patients (n = 32), a biopsy of the MSG was performed, and stimulated salivary flow was assessed. Beginning in 2002, unstimulated salivary flow was also assessed. Scores for the severity of symptoms, according to the decayed/missing/filled teeth (DMF) index, were recorded. Associations between measures of salivary flow and covariates characterizing pathology were examined.
A definite association between stimulated salivary flow and the MSG focus score, the grade of MSG fibrosis, the duration of dry mouth symptoms, and the DMF score was observed. In contrast, unstimulated salivary flow was not associated with fibrosis, atrophy, the DMF score, or the duration of dry mouth symptoms. In patients with primary SS, the DMF score was associated with pathologic changes in the MSG. Among patients with sicca, 57.9% had an abnormal unstimulated salivary flow rate (versus 82.4% of patients with primary SS), and 15.2% had an abnormal stimulated salivary flow rate (versus 61.8% of patients with primary SS). Among patients with sicca, neither stimulated salivary flow nor unstimulated salivary flow was associated with the degree of fibrosis or atrophy or with the DMF score.
Compared with unstimulated salivary flow, stimulated salivary flow appeared to be a better measure of inflammation (according to the focus score) and fibrosis. In patients with sicca, the unstimulated salivary flow rate appeared to be abnormal more commonly compared with the stimulated salivary flow rate. In the future, stimulated salivary flow may serve as a noninvasive surrogate biomarker of inflammation and fibrosis as well as a measure of response to treatment in patients with primary SS.
确定唾液流速的测量指标，即刺激后或未刺激时的流速，哪一个与小涎腺（MSG）活检标本中的病理变化关联最为紧密，并探讨原发性干燥综合征（SS）患者唾液流速与口腔表面损伤、疾病持续时间及症状严重程度之间的相关性。
对所有患者（n = 32）进行MSG活检，并评估刺激唾液流速。从2002年开始，也对未刺激唾液流速进行评估。根据龋失补牙（DMF）指数记录症状严重程度评分。研究唾液流速测量指标与表征病理的协变量之间的关联。
观察到刺激唾液流速与MSG灶性评分、MSG纤维化程度、口干症状持续时间及DMF评分之间存在明确关联。相比之下，未刺激唾液流速与纤维化、萎缩、DMF评分或口干症状持续时间无关。在原发性SS患者中，DMF评分与MSG的病理变化相关。在口干燥症患者中，57.9%的患者未刺激唾液流速异常（而原发性SS患者为82.4%），15.2%的患者刺激唾液流速异常（而原发性SS患者为61.8%）。在口干燥症患者中，刺激唾液流速和未刺激唾液流速均与纤维化或萎缩程度以及DMF评分无关。
与未刺激唾液流速相比，刺激唾液流速似乎是炎症（根据灶性评分）和纤维化的更好测量指标。在口干燥症患者中，未刺激唾液流速异常的情况似乎比刺激唾液流速更常见。未来，刺激唾液流速可能作为原发性SS患者炎症和纤维化的非侵入性替代生物标志物以及治疗反应的测量指标。
