Neuro-Ophthalmology Unit, Ophthalmology Division, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
4 Lea Imenu St, Modiin 7176253, Israel.
Medicina (Kaunas). 2022 Jan 24;58(2):175. doi: 10.3390/medicina58020175.
Hyposalivation and xerostomia can result from a variety of conditions. Diagnosis is based on a combination of medical history, clinical and serological parameters, imaging, and minor salivary gland biopsy when indicated. The Objective was to characterize microscopic changes in minor salivary gland biopsies taken in patients with xerostomia. 10-year retrospective analysis of minor salivary gland biopsies, 2007-2017. Histomorphometric analysis included gland architecture, fibrosis, fat replacement, inflammation and stains for IgG/IgG4, when relevant. 64 consecutive biopsies, of which 54 had sufficient tissue for diagnosis of Sjogren's Syndrome (SS) were included (18 males, 46 females, average age 56 (±12.5) years). Only 12 (22.2%) were microscopically consistent with SS, none stained for IgG4. Medical conditions were recorded in 40 (63%), most frequently hypertension and hyperlipidemia (28% each). Medications were used by 45 (70%), of which in 50% more than one. Xerostomia in non-SS cases was supported by abnormal gland morphology, including acinar atrophy, fibrosis and fatty replacement. All morphological abnormalities are correlated with age, while fatty replacement correlated with abnormal lipid metabolism. Multiple medications correlated with microscopic features which did not correspond with SS. SS was confirmed in a minority of cases, while in the majority fatty replacement, fibrosis and multiple medications can explain xerostomia, and are related to aging and medical conditions. Medical history and auxiliary tests could lead to correct diagnosis in non-SS patients, avoiding biopsy. The necessity of a diagnostic biopsy should be given serious consideration only after all other diagnostic modalities have been employed.
唾液分泌减少和口干可由多种情况引起。诊断基于病史、临床和血清学参数、影像学以及有指征时的小唾液腺活检的综合结果。本研究旨在描述口干患者的小唾液腺活检的微观变化。对 2007 年至 2017 年的小唾液腺活检进行了 10 年回顾性分析。组织形态计量学分析包括腺体结构、纤维化、脂肪替代、炎症和 IgG/IgG4 染色（如果相关）。共纳入 64 例连续活检，其中 54 例有足够的组织可诊断干燥综合征（SS）（18 名男性，46 名女性，平均年龄 56（±12.5）岁）。仅有 12 例（22.2%）在显微镜下与 SS 一致，无一例染色 IgG4。40 例（63%）记录了相关的医学状况，最常见的是高血压和高血脂（各 28%）。45 例（70%）使用了药物，其中 50%使用了不止一种药物。非 SS 病例的口干与异常腺体形态相关，包括腺泡萎缩、纤维化和脂肪替代。所有形态学异常均与年龄相关，而脂肪替代与异常脂质代谢相关。多种药物与不符合 SS 的微观特征相关。SS 在少数病例中得到证实，而在大多数情况下，脂肪替代、纤维化和多种药物可以解释口干，并与衰老和医学状况有关。在非 SS 患者中，辅助检查和病史可能有助于明确诊断，避免活检。只有在使用了所有其他诊断方法后，才应认真考虑进行诊断性活检。
