Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY.
Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA.
Medicine (Baltimore). 2021 Apr 2;100(13):e25325. doi: 10.1097/MD.0000000000025325.
Minor salivary gland biopsy (MSGB) is often used in patients lacking specific autoantibodies (seronegative patients) to confirm the presence of focal lymphocytic sialadenitis (FLS), which would suggest a diagnosis of Sjogren syndrome. There are no current guidelines indicating when to refer patients for MSGB. The objective of our study was to ascertain distinguishing clinical and laboratory features among individuals with sicca symptoms based on their serologic and histopathologic status, and to identify factors associated with FLS.Using a cross-sectional study design, patients ages 18 years or older with sicca symptoms who had MSGB performed at the University of Iowa from January 2000 to December 2016 were selected for chart reviews. The clinical and laboratory features of patients with and without FLS were analyzed using exact univariate and multivariable logistic regression, with Bonferroni correction for multiple comparisons.We identified 177 patients who had MSGB performed and available clinical data. A total of 133 patients had FLS, 37 (27.8%) were seropositive (positive-anti-Sjogren syndrome type A [SSA] and/or anti-Sjogren syndrome type B) and 96 (72.2%) were seronegative. Dry eyes (unadjusted odds ratio [OR]: 5.17, 95% confidence interval [CI]: 1.16-26.30; adjusted odds ratio [aOR]: 12.58, 95% CI: 1.70-167.77) and the presence of anti-SSA (OR: 7.16, 95% CI: 1.70-64.24; aOR: 8.82, 95% CI: 1.73-93.93) were associated with FLS. Smoking (aOR 0.27, 95% CI: 0.11-0.63) and antihistamine use (aOR 0.23, 95% CI: 0.08-0.63) were associated with lower odds of FLS.Our study suggests that dry eyes and anti-SSA positivity are associated with FLS. Smoking and antihistamine use were associated with lower odds of FLS. In the appropriate clinical context, seronegative patients with sicca symptoms and no smoking history could be considered for MSGB. A thorough medication and smoking history should be performed in all patients before referral for MSGB.
小唾液腺活检（MSGB）常用于缺乏特定自身抗体（血清阴性患者）的患者中，以确认局灶性淋巴细胞性涎腺炎（FLS）的存在，这提示干燥综合征的诊断。目前尚无指南表明何时应将患者转介进行 MSGB。我们的研究目的是确定基于血清学和组织病理学状态的口干症状个体之间具有鉴别特征的临床和实验室特征，并确定与 FLS 相关的因素。
使用横断面研究设计，选择 2000 年 1 月至 2016 年 12 月在爱荷华大学进行 MSGB 的年龄在 18 岁或以上的口干症状患者进行图表回顾。使用确切的单变量和多变量逻辑回归分析有和没有 FLS 的患者的临床和实验室特征，并使用 Bonferroni 校正进行多重比较。
我们确定了 177 名进行 MSGB 且具有临床数据的患者。共有 133 名患者有 FLS，37 名（27.8%）为血清阳性（抗干燥综合征 A 型 [SSA] 和/或抗干燥综合征 B 型阳性），96 名（72.2%）为血清阴性。干眼症（未调整的优势比 [OR]：5.17，95%置信区间 [CI]：1.16-26.30；调整后的优势比 [aOR]：12.58，95% CI：1.70-167.77）和抗 SSA 的存在（OR：7.16，95% CI：1.70-64.24；aOR：8.82，95% CI：1.73-93.93）与 FLS 相关。吸烟（aOR 0.27，95% CI：0.11-0.63）和抗组胺药物使用（aOR 0.23，95% CI：0.08-0.63）与 FLS 的可能性降低相关。
我们的研究表明，干眼症和抗 SSA 阳性与 FLS 相关。吸烟和抗组胺药物的使用与 FLS 的可能性降低相关。在适当的临床环境中，无吸烟史的口干症状且血清阴性的患者可以考虑进行 MSGB。在转介进行 MSGB 之前，应在所有患者中进行全面的药物和吸烟史评估。
