Conticini Edoardo, Bardelli Marco, Vitale Antonio, De Stefano Renato, Falsetti Paolo, Selvi Enrico, Bacarelli Maria Romana, D'Alessandro Roberto, Cantarini Luca, Frediani Bruno, Gentileschi Stefano
Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy.
Reumatologia. 2023;61(2):109-115. doi: 10.5114/reum/163213. Epub 2023 May 10.
Based on ACR/EULAR classification criteria, minor salivary glands biopsy (MSGB) is a useful diagnostic tool for the diagnosis of primary Sjögren's syndrome (SS). The main objective of our study was to evaluate the diagnostic role of MSGB, as well as to highlight correlations between histological findings and autoimmune profiles.
We retrospectively evaluated histological and autoimmunity data from patients who underwent MSGB in our department in cases of suspected SS, from March 2011 to December 2018. Salivary gland samples were evaluated using Chisholm and Mason (CM) grading and the focus score (FS).
A total of 1,264 patients (108 males, 1,156 females) were included. The median age was 55.22 ±13.51 years (range: 15-87). In univariate binary logistic regression, CM ≥ 3 and FS ≥ 1 were significantly predicted by antinuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-Ro/SSA titer as well as anti-La/SSB, anti-Ro/SSA, rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) positivity. In multivariate analysis, CM ≥ 3 and MSGB positivity were significantly associated with ANA titer; FS ≥ 1 was not associated with laboratory findings. A positive biopsy was associated with laboratory findings, as ANA and ENA titers, anti-Ro/SSA, anti-La/SSB, RF and ACPA positivity may discriminate patients with SS-related histological findings.
Minor salivary glands biopsy is a useful tool to diagnose SS in cases of highly suggestive clinical symptoms but in the absence of a specific autoimmunity.
根据美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）分类标准，小唾液腺活检（MSGB）是诊断原发性干燥综合征（SS）的一种有用的诊断工具。我们研究的主要目的是评估MSGB的诊断作用，并突出组织学发现与自身免疫谱之间的相关性。
我们回顾性评估了2011年3月至2018年12月在我们科室因疑似SS接受MSGB的患者的组织学和自身免疫数据。使用奇泽姆和梅森（CM）分级及灶性评分（FS）对唾液腺样本进行评估。
共纳入1264例患者（108例男性，1156例女性）。中位年龄为55.22±13.51岁（范围：15 - 87岁）。在单变量二元逻辑回归中，抗核抗体（ANA）、抗可提取核抗原（ENA）、抗Ro/SSA滴度以及抗La/SSB、抗Ro/SSA、类风湿因子（RF）和抗瓜氨酸化蛋白抗体（ACPA）阳性可显著预测CM≥3和FS≥1。在多变量分析中，CM≥3和MSGB阳性与ANA滴度显著相关；FS≥1与实验室检查结果无关。活检阳性与实验室检查结果相关，因为ANA和ENA滴度、抗Ro/SSA、抗La/SSB、RF和ACPA阳性可区分具有SS相关组织学发现的患者。
小唾液腺活检是在临床症状高度提示但缺乏特异性自身免疫的情况下诊断SS的一种有用工具。
