Daniels Troy E, Cox Darren, Shiboski Caroline H, Schiødt Morten, Wu Ava, Lanfranchi Hector, Umehara Hisanori, Zhao Yan, Challacombe Stephen, Lam Mi Y, De Souza Yvonne, Schiødt Julie, Holm Helena, Bisio Patricia A M, Gandolfo Mariana S, Sawaki Toshioki, Li Mengtao, Zhang Wen, Varghese-Jacob Beni, Ibsen Per, Keszler Alicia, Kurose Nozomu, Nojima Takayuki, Odell Edward, Criswell Lindsey A, Jordan Richard, Greenspan John S
University of California, San Francisco, CA, USA.
Arthritis Rheum. 2011 Jul;63(7):2021-30. doi: 10.1002/art.30381.
To examine associations between labial salivary gland (LSG) histopathology and other phenotypic features of Sjögren's syndrome (SS).
The database of the Sjögren's International Collaborative Clinical Alliance (SICCA), a registry of patients with symptoms of possible SS as well as those with obvious disease, was used for the present study. LSG biopsy specimens from SICCA participants were subjected to protocol-directed histopathologic assessments. Among the 1,726 LSG specimens exhibiting any pattern of sialadenitis, we compared biopsy diagnoses against concurrent salivary, ocular, and serologic features.
LSG specimens included 61% with focal lymphocytic sialadenitis (FLS; 69% of which had focus scores of ≥1 per 4 mm²) and 37% with nonspecific or sclerosing chronic sialadenitis (NS/SCS). Focus scores of ≥1 were strongly associated with serum anti-SSA/SSB positivity, rheumatoid factor, and the ocular component of SS, but not with symptoms of dry mouth or dry eyes. Those with positive anti-SSA/SSB were 9 times (95% confidence interval [95% CI] 7.4-11.9) more likely to have a focus score of ≥1 than were those without anti-SSA/SSB, and those with an unstimulated whole salivary flow rate of <0.1 ml/minute were 2 times (95% CI 1.7-2.8) more likely to have a focus score of ≥1 than were those with a higher flow rate, after controlling for other phenotypic features of SS.
Distinguishing FLS from NS/SCS is essential in assessing LSG biopsies, before determining focus score. A diagnosis of FLS with a focus score of ≥1 per 4 mm², as compared to FLS with a focus score of <1 or NS/SCS, is strongly associated with the ocular and serologic components of SS and reflects SS autoimmunity.
研究唇腺组织病理学与干燥综合征（SS）其他表型特征之间的关联。
本研究使用了干燥综合征国际协作临床联盟（SICCA）的数据库，该数据库登记了可能患有SS症状以及明显患有该病的患者。对SICCA参与者的唇腺活检标本进行了方案指导的组织病理学评估。在1726份表现出任何涎腺炎模式的唇腺标本中，我们将活检诊断结果与同时出现的唾液、眼部和血清学特征进行了比较。
唇腺标本中，61%为局灶性淋巴细胞性涎腺炎（FLS；其中69%的病灶评分≥1个/4mm²），37%为非特异性或硬化性慢性涎腺炎（NS/SCS）。病灶评分≥1与血清抗SSA/SSB阳性、类风湿因子以及SS的眼部表现密切相关，但与口干或干眼症状无关。抗SSA/SSB阳性者病灶评分≥1的可能性是抗SSA/SSB阴性者的9倍（95%置信区间[95%CI]7.4 - 11.9），在控制了SS的其他表型特征后，未刺激全唾液流速<0.1ml/分钟者病灶评分≥1的可能性是流速较高者的2倍（95%CI 1.7 - 2.8）。
在确定病灶评分之前，区分FLS和NS/SCS对于评估唇腺活检至关重要。与病灶评分<1的FLS或NS/SCS相比，诊断为病灶评分≥1个/4mm²的FLS与SS的眼部和血清学表现密切相关，反映了SS的自身免疫性。
