Dupond J L, de Wazières B, Saile R, Closs F, Viennet G, Kantelip E, Fest T, Vuitton D A
Service de médecine interne, hôpital Jean-Minjoz, CHRU, Besançon, France.
Rev Med Interne. 1995;16(5):314-7. doi: 10.1016/0248-8663(96)80716-8.
Primary and secondary amyloidosis are not uncommon in aging but the diagnosis is rarely made on account of the risk of bleeding in the site of biopsies and the difficulty to distinguish senile from systemic amyloidosis on the biopsy samples. We have studied the frequency of amyloid deposition in the abdominal fat aspirate (AFA), the labial salivary gland (LSG), the temporal arteries (four cases), bone marrow (two cases), digestive tract (four cases) in 100 elderly patients (aged 80 or greater). AFA was positive in 15 percent of the patients and LSG in 5%; both samples were positive in 4%. Four cases of systemic amyloidosis were found (two of the AL and two of the AA type). Sensitivity of AFA was 75%, specificity was 87% and the positive predictive value was 20%. The values were respectively 100%, 99%, 100% for LSG. In 11 patients whose AFA biopsies samples were singly positive, amyloid deposits were found in temporal arteries in four of four cases. We conclude that AFA is too sensitive for the diagnosis of systemic amyloidosis in aging. The responsibility of senile amyloid deposition on AFA should require further investigations. LSG biopsies seem to be a more reliable test for the diagnosis of primary and secondary amyloidosis in elderly.
原发性和继发性淀粉样变性在老年人中并不罕见，但由于活检部位存在出血风险且难以通过活检样本区分老年性淀粉样变性与系统性淀粉样变性，故很少能做出诊断。我们研究了100例80岁及以上老年患者腹部脂肪抽吸物（AFA）、唇唾液腺（LSG）、颞动脉（4例）、骨髓（2例）、消化道（4例）中淀粉样沉积的频率。15%的患者AFA呈阳性，5%的患者LSG呈阳性；两种样本均呈阳性的占4%。发现4例系统性淀粉样变性（2例为AL型，2例为AA型）。AFA的敏感性为75%，特异性为87%，阳性预测值为20%。LSG的相应数值分别为100%、99%、100%。在11例AFA活检样本单独呈阳性的患者中，4例中有4例在颞动脉中发现淀粉样沉积。我们得出结论，AFA对老年人系统性淀粉样变性的诊断过于敏感。AFA上老年性淀粉样沉积的原因需要进一步研究。LSG活检似乎是诊断老年人原发性和继发性淀粉样变性更可靠的检查方法。
