Goodman A, Ramos R, Petrelli M, Hirsch S A, Bukowski R, Harris J W
Ann Intern Med. 1978 Oct;89(4):501-4. doi: 10.7326/0003-4819-89-4-501.
Gingival biopsy has been advocated as a readily available, safe, rapid histologic confirmation of the clinical diagnosis of thrombotic thrombocytopenic purpura. Eighteen gingival biopsies from 16 patients with proven thrombotic thrombocytopenic purpura were reviewed. Seven (39%) showed characteristic histologic changes: [1] subendothelial hyalinelike deposits; [2] intraluminal deposits; [3] lack of inflammatory change in vessels and stroma. To assess specificity, gingival sections from 154 patients with oral pathology only and from 50 unselected autopsies were reviewed: 10% to 20% of biopsies from patients with oral pathology only (primarily inflammation) and three of 50 autopsy specimens showed occasional intraluminal deposits but no subendothelial deposits. In addition, other histologic features permitted them to be distinguished from thrombotic thrombocytopenic purpura. We conclude that gingival biopsy in thrombotic thrombocytopenic purpura, although helful in confirming the diagnosis, is less often positive than has been suggested. Biopsy of grossly inflamed gingiva should be avoided.
牙龈活检被认为是一种易于获取、安全且能快速进行组织学确认血栓性血小板减少性紫癜临床诊断的方法。对16例经证实的血栓性血小板减少性紫癜患者的18次牙龈活检进行了回顾。7例（39%）显示出特征性组织学改变：[1]内皮下玻璃样沉积物；[2]管腔内沉积物；[3]血管和间质无炎症改变。为评估特异性，对154例仅患有口腔病理疾病的患者的牙龈切片以及50例未经选择的尸检标本进行了回顾：仅患有口腔病理疾病的患者（主要为炎症）的活检标本中有10%至20%以及50例尸检标本中有3例显示偶尔有管腔内沉积物，但无内皮下沉积物。此外，其他组织学特征使它们能够与血栓性血小板减少性紫癜区分开来。我们得出结论，血栓性血小板减少性紫癜的牙龈活检虽然有助于确诊，但阳性率比之前认为的要低。应避免对明显发炎的牙龈进行活检。
