IgG4相关唾液腺炎25例临床分析

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (2): 128-133.

IgG4相关唾液腺炎25例临床分析

王知俊, 郑凌艳, 浦益萍, 谢李松, 石欢, 俞创奇

上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海 200011

收稿日期:2015-01-12 出版日期:2016-03-20 发布日期:2016-04-06
通讯作者: 俞创奇,E-mail:ycq616@hotmail.com
作者简介:王知俊（1988-）,男,硕士,住院医师,E-mail:wangzhijun88@gmail.com
基金资助:
国家自然科学基金(81100766)

Clinical analysis and differential diagnosis of 25 patients with IgG4-related sclerosing sialadenitis

WANG Zhi-jun, ZHENG Ling-yan, PU Yi-ping, XIE Li-song, SHI Huan, YU Chuang-qi

Department of Oral Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine;Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Received:2015-01-12 Online:2016-03-20 Published:2016-04-06

摘要/Abstract

摘要： 目的:分析IgG4相关唾液腺炎和有“唾液腺肿大”类似表现的常见唾液腺非肿瘤疾病的特点,明确其临床鉴别诊断要点。方法:回顾分析诊断为IgG4相关唾液腺炎患者的临床资料,与有腺体肿大类似表现的唾液腺非肿瘤疾病进行比较,重点从病史及临床表现、血液免疫学和组织病理学方面比较IgG4相关唾液腺炎与舍格伦综合征（Sjögren’s syndrome,SS）的差异,应用SAS 8.0软件包对数据进行非参数统计。结果:335例唾液腺非肿瘤疾病患者纳入本研究,包括IgG4相关唾液腺炎25例、阻塞性唾液腺炎279例和SS 31例。比较IgG4相关唾液腺炎与阻塞性唾液腺炎和SS的疾病特点可见,其在病史及临床检查、血液免疫学和组织病理学等方面均有各自特点,差异显著。结论:IgG4相关唾液腺炎是一类以唾液腺肿大为典型表现的唾液腺慢性炎症,临床上应综合多方面考虑,与其他可能引起唾液腺肿大症状的疾病明确鉴别,准确诊断,为进一步制订合理的治疗方案提供依据。

Abstract: PURPOSE: To discuss the clinical features of IgG4-related sclerosing sialadenitis and salivary glands non-neoplastic diseases presenting gland swelling, to make clear the key points of clinical differential diagnosis. METHODS: We retrospectively analyzed and compared the clinical data of IgG4-related sclerosing sialadenitis with those of salivary glands non-neoplastic diseases especially Sjögren’s syndrome (SS) in medical history, clinical examination, serology and pathology. The statistical analysis was performed using SAS 8.0 software package. RESULTS: Three hundred and thirty-five patients with salivary glands non-neoplastic diseases were included in the study, including 25 IgG4-related sclerosing sialadenitis, 279 obstructive sialadenitis and 31 SS. We compared IgG4-related sclerosing sialadenitis with the others and found out significant differences in each aspects. CONCLUSIONS: IgG4-related sclerosing sialadenitis is a kind of chronic salivary gland inflammation with glands swelling. In order to make a definite diagnosis with other salivary glands non-neoplastic diseases, a comprehensive analysis is needed.

Key words: IgG4-related sclerosing sialadenitis, Obstructive sialadenitis, Sjögren’s syndrome

中图分类号:

R781.7

王知俊, 郑凌艳, 浦益萍, 谢李松, 石欢, 俞创奇. IgG4相关唾液腺炎25例临床分析[J]. 中国口腔颌面外科杂志, 2016, 14(2): 128-133.

WANG Zhi-jun, ZHENG Ling-yan, PU Yi-ping, XIE Li-song, SHI Huan, YU Chuang-qi. Clinical analysis and differential diagnosis of 25 patients with IgG4-related sclerosing sialadenitis[J]. China J Oral Maxillofac Surg, 2016, 14(2): 128-133.

参考文献

[1] Masaki Y, Sugai S, Umehara H. IgG4-related diseases including Mikulicz’s disease and sclerosing pancreatitis: diagnostic insights [J]. J Rheumatol, 2010, 37(7): 1380-1385.
[2] Deshpande V, Zen Y, Chan JK, et al. Consensus statement on the pathology of IgG4-related disease [J]. Mod Pathol, 2012, 25(9): 1181-1192.
[3] Geyer JT, Deshpande V. IgG4-associated sialadenitis [J]. Curr Opin Rheumatol, 2011, 23(1): 95-101.
[4] Takahashi H, Yamamoto M, Shinomura Y, et al. Long-term outcomes and necessity of early intervention for IgG4-related disease [J]. Nihon Rinsho Meneki Gakkai Kaishi, 2013, 36(6): 442-451.
[5] Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group[J]. Ann Rheum Dis, 2002, 61(6): 554-558.
[6] Wang ZJ, Zheng LY, Pu YP, et al. Clinical features and treatment outcomes of immunoglobulin G4-related sclerosing sialadenitis[J]. J Craniofac Surg, 2014, 25(6): 2089-2093.
[7] 王知俊, 俞创奇, 郑凌艳, 等. IgG4相关唾液腺炎临床诊疗特点[J]. 口腔颌面外科杂志, 2013, 23(6): 432-437.
[8] Bamba R, Sweiss NJ, Langerman AJ, et al. The minor salivary gland biopsy as a diagnostic tool for Sjögren syndrome [J]. Laryngoscope, 2009, 119(10): 1922-1926.
[9] Takano K, Yamamoto M, Takahashi H, et al. Clinicopathologic similarities between Mikulicz's disease and Küttner tumor [J]. Am J Otolaryngol, 2010, 31(6): 429-434.
[10] Yamamoto M, Harada S, Ohara M, et al. Clinical and pathological differences between Mikulicz's disease and Sjögren’s syndrome [J]. Rheumatology (Oxford), 2005, 44(2): 227-234.
[11] Moriyama M, Tanaka A, Maehara T, et al. Clinical characteristics of Mikulicz's disease as an IgG4-related disease[J]. Clin Oral Investig, 2013, 17(9): 1995-2002.
[12] Takahashi H, Yamamoto M, Tabeya T, et al. The immunobiology and clinical characteristics of IgG4 related diseases[J]. J Autoimmun, 2012, 39(1-2): 93-96.