85例舍格伦综合征腮腺表现的临床分析与探讨

目的　为了明确舍格伦综合征腮腺表现的特点;以及与其它临床表现之间的关系。方法　对85例舍格伦综合征患者的临床资料进行回顾性分析,并结合文献进一步进行探讨。结果　舍格伦综合征的腮腺表现以炎症型最多;肥大型次之;类肿瘤型最少;三者与口干燥之间的关系存在显著差异;部分患者有恶变可能。结论　舍格伦综合征腮腺表现的特点是该病诊断的一个重要依据,临床应引起重视     

舍格伦综合征患者腮腺造影追踪观察

作者报告３６例舍格伦综合征Ｘ线追踪观察结果。追踪时间５～７２个月，平均２５个月。参考国际分类标准将患者分为三组：继发组１４例（眼干或（和）口干及结缔组织病）；原发组１４例（口干和眼干）；可能组８例（仅口干或眼干）。追踪结果各组Ｘ线表现：①形态无改变，功能更加迟缓，最早可发生在５个月后；②末梢导管点状扩张（点扩）增多；③点状扩张减少，末梢导管球状扩张（球扩）增多；④点、球、腔扩及阴性涎石；⑤向心性萎缩。本组资料显示：①眼干及结缔组织病继发组、仅眼干的可能组内，对腮腺影响不大，造影改变不明显，无点状扩张，而呈阴性涎石伴管炎改变，要结合临床才能与慢性阻塞性腮腺炎鉴别；②总唾液流率与腮腺造影改变呈负相关关系，总唾液流率低者腮腺造影点扩多，反之亦然。     

腮腺舍格伦综合征与非霍奇金淋巴瘤相关性分析

目的:了解腮腺非霍奇金淋巴瘤与舍格伦综合征的临床及发病机制的相关性，正确诊断和治疗舍格伦综合征，尽早明确有无恶性变。方法：对142例口腔颌面部的非霍奇金淋巴瘤中21例发生在腮腺的非霍奇金淋巴瘤，及3例从合格伦综合征演变成淋巴瘤的病例进行分析。结果：21例腮腺区非霍奇金淋巴瘤的局部表现主要为肿块、反复肿胀，与类肿瘤型舍格伦综合征的一般特征和腮腺表现有相关性，其中3例腮腺淋巴瘤患者有明确的舍格伦综合征病史。结论：舍格伦综合征与腮腺非霍奇金淋巴瘤的发生发展，以及临床表现有相关性，部分类肿瘤型舍格伦综合征可演变为淋巴瘤，临床表现和免疫学改变可早期判断舍格伦综合征有无恶性变。     

不同腮腺症状原发性舍格伦综合征的血清学分析

目的:研究不同腮腺症状的原发性舍格伦综合征(primary Sj觟gren’s syndrome,p SS)患者之间的血清学特征的差异性。方法:回顾性研究289名患者,均符合原发性舍格伦综合征(2002年修订的欧美联合诊断标准)。依据患者腮腺的临床特征,将患者分为以下4组:第1组(类肿瘤组)、第2组(感染组)、第3组(肿大组)、第4组(口干组)。对比各组之间的人口统计学和血清学特征。每两组之间结果的统计学分析用t检验,F检验,卡方检验,方差分析。结果:不同的腮腺临床特征的p SS患者具有不同的血清学表型。第1组的血清免疫球蛋白Ig G值是4组中最高的,而补体C4是4组中最低的。第2组的血清免疫球蛋白Ig E值是4组中最高的。第3组的血沉值是4组中最高的。结论 :不同腮腺临床症状的p SS患者具有不同的血清学表型。这可能有助于增进我们对该疾病的认识。     

舍格伦综合征动物模型的研究

由于对舍格伦综合征的病因及发病过程还不十分清楚 ,给临床的诊断和治疗带来了不少困难。动物实验是目前研究工作的重要内容之一 ,掌握各种动物模型的特点 ,选择适合的模型是实验成败的关键。本文选择常用的十余种舍格伦综合征动物模型按自发型和诱发型分类 ,对各自特点进行综述。     

舍格伦综合征亚临床型

目的进一步观察舍格伦综合征（Ｓｊ¨ｏｇｒｅｎ＇ｓｓｙｎｄｒｏｍｅ，ＳＳ）亚临床型的各种表现及治疗。方法对２４例ＳＳ亚临床型患者长期临床观察，并行实验室、腮腺造影及肌内注射胸腺肽治疗。结果２４例患者在出现口干、眼干之前有腮腺反复肿胀史２～１７年（平均７年），均误诊为“慢性化脓性腮腺炎”或“腮腺腺炎”，追踪观察均为典型的ＳＳ。２４例中有１０例患者同时伴有脉管炎或出血性紫癜，占４０％，脉管系统受累较普遍。腮腺造影以末梢导管扩张伴主导管扩张及边缘粗糙为主，１２／２４例，占７０％。肌内注射胸腺肽能明显减少腮腺反复肿胀发作频率。结论提出ＳＳ亚临床型对澄清慢性腮腺炎症命名及分类上的混乱有实际意义，并对早期诊治ＳＳ有指导意义。肌内注射胸腺肽能减少肿胀发作频率。     

舍格伦综合征治疗的进展

舍格伦综合征 (Ｓｊｏｇｒｅｎ’ｓＳｙｎｄｒｏｍｅ,ＳＳ)是一种临床较为常见的以外分泌腺病变为主的慢性系统性自身免疫病。由于病因尚未明确 ,因而缺乏理想的治疗方法。近年来 ,不断有新药物、新技术包括匹鲁卡品、环孢菌素Ａ、细胞因子、单克隆抗体等被应用于ＳＳ的治疗中来 ,本文就这些新方法的治疗现状及其作用机制综述如下。一、全身治疗1.催涎剂匹鲁卡品 (Ｐｉｌｏｃａｒｐｉｎｅ ,毛果芸香碱 ) :为直接作用于Ｍ -受体的拟胆碱药 ,对平滑肌、外分泌腺组织 (涎腺、泪腺 )有很强的作用 ,可刺激唾液腺分泌。Ｐａｐａｓ及Ｔａｋａｙａ等…     

舍格伦综合征病因研究进展

<正>舍格伦综合征(Sjgren's syndrome,SS)又称干燥综合征,是一种由淋巴细胞介导的以损伤外分泌腺为主的系统性自身免疫性疾病。由于其免疫性炎症反应主要表现在外分泌腺体的上皮细胞,故又名自身免疫性外分泌腺体上皮细胞炎,或自身免疫性外分泌病。临床除有唾液腺和泪腺受损、功能下降,     

类肿瘤型舍格伦综合征46例临床分析

目的：通过临床资料分析,进一步探讨类肿瘤型舍格伦综合征的临床表现和治疗方法。方法：结合文献复习,对46例类肿瘤型舍格伦综合征的临床表现和治疗进行回顾性分析。结果：46例患者的局部表现主要为1个或1个以上肿块,伴有口干症19例（41％）,眼干症11例（23％）,有自身抗体8例（17％）,治疗结果,手术组25例全部有效,但有5例异位复发;药物组21例,有效17例,有8例原位复发,手术组有1例,药物组2例于治疗后随访中出现恶变。结论：类肿瘤型舍格伦综合征局部表现主要为肿块,部分患者有全身表现,少数可发生恶变,治疗应采取局部与全身,药物与手术相结合的方法。治疗前明确诊断,首选药物治疗,若疗效不明显或反复出现肿块,宜及时手术治疗。     

老年人舍格伦综合征1例报告

舍格伦综合征是一种自身免疫性疾病,其特征表现为外分泌腺的进行性破坏,导致黏膜及结膜干燥,并伴有自身免疫性病征.病变限于外分泌腺本身者,称为原发性舍格伦综合征.同时伴有其他自身免疫性疾病,如类风湿关节炎等,称为继发性舍格伦综合征.我科曾遇老年人舍格伦综合征1例,现报告如下.     

超声弹性成像在干燥综合征唾液腺病变中的应用价值

目的: 探讨超声弹性成像技术中应变率比值法（SR）和声辐射力脉冲成像法（ARFI）在干燥综合征（SS）唾液腺病变诊断中的应用价值。方法: 收集 2017年1月—2017年7月上海交通大学医学院附属第九人民医院口腔外科门诊确诊的干燥综合征患者36例,健康对照病例25例。对双侧腮腺及下颌下腺进行SR及ARFI检查,获得双侧腮腺及下颌下腺的SR和剪切波速度（SWV）。比较同一组内腮腺、下颌下腺左侧与右侧之间以及不同组间同侧腮腺、下颌下腺 SR和SWV 的差异。采用SPSS 22.0软件包对数据进行统计学分析。结果: ①无论SS组还是健康对照组,左、右侧腮腺及下颌下腺之间SR值和SWV值差异均无显著性（P>0.05）;组间双侧腮腺、下颌下腺SR值差异均有显著性（P<0.05）;组间腮腺、下颌下腺SWV值差异均有显著性（P<0.05）。②以0.8962为截断值,采用SR检测腮腺、诊断SS的敏感度为77.8%,特异度为88.0%,曲线下面积达0.844;以0.8987为截断值,采用SR检测下颌下腺、诊断SS的敏感度为47.22%,特异度为84.0%,曲线下面积达0.652。③以1.6288为截断值,采用ARFI技术检测腮腺、诊断SS的敏感度为91.7%,特异度为88.0%,曲线下面积达0.943;以1.8788为截断值,采用ARFI技术检测下颌下腺、诊断SS的敏感度为44.4%,特异度为96.0%,曲线下面积0.614。结论: 超声弹性成像技术SR及ARFI可以提供腮腺及下颌下腺SR及SWV值,定量分析SS患者的腺体硬度,在临床诊断干燥综合征中有很好的应用价值。     

干燥综合征患者牙种植1例

本文报告1例干燥综合征患者行种植牙治疗并随访1年多的病例,患者确诊干燥综合征5年并长期规范服用糖皮质激素,在15、16、44、46区植入ITI亲水种植体共4枚,术后口服抗生素以预防感染,并加服“生骨片”以促进种植体骨整合,患者自备糖皮质激素控制干燥综合征。之后患者于其他牙位又植入6枚种植体。随访1年多,患者修复体稳固,牙龈无红肿,锥形束CT重建显示种植体骨结合良好。     

表皮生长因子与干燥综合征伴发萎缩性舌炎的相关性研究

目的： 探讨表皮生长因子(epidermal growth factor,EGF)及其受体（EGF receptor,EGFR)与干燥综合征（Sjögren’s syndromes,SS)伴发萎缩性舌炎（atrophic glossitis,AG)的相关性及可能的作用机制。方法：干燥综合征患者按未伴发与伴发轻、中、重度萎缩性舌炎分为4组,健康成年人为对照组,应用ELISA法检测唾液中的EGF含量,SP免疫组化技术检测舌上皮细胞中EGFR的表达情况,采用SPSS19.0软件包进行统计学处理。结果：干燥综合征未伴发及伴发萎缩性舌炎组唾液EGF浓度均显著低于正常对照组(P<0.01),2组之间差异显著（P=0.024）,干燥综合征伴发轻、中、重萎缩性舌炎组唾液EGF水平逐渐降低,两两比较差异显著（P<0.05）;干燥综合征伴发中、重度萎缩性舌炎组舌上皮细胞EGFR表达较正常对照组显著降低（P=0.009,P=0.037）,其余2组与对照组之间差异无显著性;舌背黏膜萎缩程度与唾液EGF水平显著相关（r=-0.673,P<0.01）。结论：干燥综合征患者唾液中表皮生长因子浓度明显降低,且与其伴发萎缩性舌炎有密切相关性。     

The minor salivary gland proteome in Sjögren's syndrome

Objective:  To identify the global protein expression (the proteome) in the minor salivary glands from primary Sjögren's syndrome (pSS) patients and non-SS controls.
Materials and methods:  Minor labial salivary glands were obtained from six pSS patients and from six age-matched non-SS controls, lysed in SDS buffer and pooled into two groups, respectively. The lysates were analysed by liquid chromatography electrospray ionization combined with tandem mass spectrometry. Also, the proteins were separated by two-dimensional polyacrylamide gel electrophoresis and protein spots were subjected to mass spectrometry.
Results:  Heat shock proteins, mucins, carbonic anhydrases, enolase, vimentin and cyclophilin B were among the proteins identified. The differences in the proteomes of minor salivary glands from pSS patients and non-SS controls were mainly related to ribosomal proteins, immunity and stress. Alpha-defensin-1 and calmodulin were among six proteins exclusively identified in pSS patients.
Conclusion:  We have identified several minor salivary gland proteins that may have implications for clarifying the SS pathophysiology. This experiment adds to the knowledge of proteins produced in salivary glands in health and disease, and may form the basis of further studies on biomarkers of prognostic and diagnostic value.     

Minor salivary gland immunohistology in the diagnosis of primary Sjögren's syndrome

Background:  Focal lymphocytic infiltrates of minor salivary glands are considered target-organ related signs of Sjögren's syndrome. The percentages of plasma cells expressing IgA, IgG and IgM in minor salivary gland biopsies have also been suggested as useful in establishing a diagnosis of Sjögren's syndrome, and this study aimed at evaluating this method.
Methods:  All biopsies from patients under investigation for Sjögren's syndrome ( n  = 210) at our department during 4 years were analyzed for IgA, IgG and IgM producing cells by immunohistochemistry, and related to Sjögren classification parameters.
Results:  A focus score ≥1 was observed in 67/210 patients and the frequency of IgA producing cells was <70% in 42/210 patients. Sufficient clinical data for classification of disease were available for 57/210 patients. Patients were classified as having primary Sjögren's syndrome (pSS) ( n  = 9), secondary Sjögren's syndrome (sSS) ( n  = 12) or non-Sjögren's syndrome (non-SS) ( n  = 36). IgA expressing cells were significantly decreased ( P  < 0.01) and IgG expressing cells significantly increased ( P  < 0.02) in patients with pSS compared to non-SS. Also, increased numbers of salivary gland IgG producing plasma cells correlated with increased IgG serum levels ( P  < 0.001). However, there was no significant difference between sSS and non-SS with regard to IgA, IgG or IgM expressing cells in the glands.
Conclusions:  Our results support previous reports indicating the relevance of quantitative evaluation of Ig isotype expression in plasma cells in the clinical investigation of Sjögren's syndrome and further indicate a difference in plasma cell populations between pSS and sSS.     

An association between salivary gland disease and serological abnormalities in Sjögren's syndrome

In the labial salivary glands (LSGs) of 16 primary and 18 secondary Sjögren's syndrome (SS) patients, infiltrating lymphocytes were histologically and immunohistochemically examined: also, the serum levels of rheumatoid factor, antinuclear antibodies, anti-DNA antibodies, anti-SS-A and anti-SS-B antibodies, and immunoglobulins (including IgG, IgM and IgA) were all assayed. An immunohistochemical analysis of the lymphocyte subsets in LSGs revealed that severe lymphocytic infiltration was frequently accompanied by marked B cell accumulation both in primary and secondary SS patients. Furthermore, local B cell accumulation was also closely associated with elevated levels of anti-SS-A and anti-SS-B antibodies and IgG, and this association was statistically significant in the group with primary SS but not in the group with secondary SS. Thus, local lymphocytic infiltration, especially B cell accumulation, in the salivary glands is suggested to be involved in serological abnormalities in primary SS. while complicated autoimmune diseases other than SS may also be involved in serological abnormalities in secondary SS.     

骨髓基质细胞抗原2在原发性舍格伦综合征中的表达及意义

目的: 检测骨髓基质细胞抗原2(bone marrow stromal antigen-2,BST-2)在原发性舍格伦综合征（primary Sjögren's syndrome,pSS）患者唇腺及外周血淋巴细胞中的表达,探讨BST-2对淋巴细胞增殖的作用,以期为原发性舍格伦综合征的发病机制研究及药物治疗靶点的开发提供理论基础。方法: 应用实时定量PCR技术检测30例pSS患者及30例对照患者外周血单个核细胞（peripheral blood mononuclear cells,PBMCs）和唇腺组织中BST-2的表达水平,并与临床指标进行相关性分析。采用免疫组织化学对唇腺组织中的BST-2进行定位及半定量分析。通过分选外周血中的淋巴细胞,实时定量 PCR明确BST-2异常表达的淋巴细胞亚群,唇腺免疫组织化学连续切片染色验证。慢病毒转染人B淋巴细胞系以过表达BST-2,CCK8检测BST-2对细胞增殖活性的影响,流式细胞术分析其对细胞凋亡的影响。采用SPSS 16.0软件包对数据进行统计学分析。结果: 与对照患者相比,pSS患者唇腺组织中BST-2表达升高,阳性细胞主要是浸润腺体的B淋巴细胞。同时,pSS患者外周血CD19⁺ B细胞BST-2与对照组相比表达升高。过表达B细胞中的BST-2可以促进细胞增殖,抑制细胞凋亡。结论: BST-2在pSS患者外周血及唇腺组织中表达升高,BST-2主要定位于B淋巴细胞。推测BST-2通过促进B细胞在腺体中的增殖和浸润,从而参与pSS的发生与发展。     

Localization of antimicrobial peptides human β-defensins in minor salivary glands with Sjögren's syndrome

Sjögren's syndrome is a common systemic autoimmune disease associated with inflammatory cells that infiltrate exocrine glands. The antimicrobial peptides human β-defensin-1, human β-defensin-2, and human β-defensin-3 are expressed in various human epithelial cells and in normal salivary glands. Antimicrobial peptides provide local protection against infection and participate in inflammatory responses. Because of the presence of inflammation, we hypothesized that human β-defensin expression in minor salivary glands may be increased in subjects with Sjögren's syndrome. However, the expression of human β-defensins 1 and 2 was decreased in salivary glands affected by Sjögren's syndrome in comparison with the human β-defensin expression patterns in salivary glands from normal subjects. In addition, the reduction in expression of human β-defensin-2 was greater than the reduction in expression of human β-defensin-1. The aforementioned result suggests that the reduction in expression of human β-defensin-2 may occur earlier than the reduction in expression of human β-defensin-1, which may lead to a greater decrease in human β-defensin-2 than in human β-defensin-1 during disease progression.     

Indicators of salivary gland inflammation in primary Sjögren's syndrome

The aim of this study was to establish additional indicators in saliva and plasma which are associated with salivary gland inflammation in patients with primary Sjögren's syndrome (SS). ELISA assays were used to determine the concentrations of sICAM-1, sVCAM-1, sIL-2Rz, IgA, IgG, calprotectin and albumin in parotid saliva, whole saliva and plasma samples. Soluble ICAM-1 was present in whole and parotid saliva samples from primary SS patients. Soluble VCAM-1 and sIL-IRx could not be detected in salivary samples from either primary SS or control subjects. IgA, IgG, calprotectin and albumin concentrations were higher in both whole and parotid saliva in the patient group compared with the control group. The results showed increased levels of calprotectin in all saliva samples compared to plasma, suggesting that calprotectin may be locally produced. Increased plasma values of sICAM-1. sVCAM-1, SIL-2Rα, IgA, IgG and calprotectin were detected in primary SS patients when compared to controls. The output/min of IgA. IgG, calprotectin and albumin was decreased in SS patients. Plasma levels of various proteins could offer information concerning glandular and extraglandular inflammatory processes. However, salivary levels of these proteins (particularly sICAM-1) tend to reflect more the local inflammatory activity, providing a convenient and non-invasive tool for diagnosis.     

Anti-cytoplasmic autoantibodies reactive with epithelial cells of the salivary gland in sera from patients with Sjögren's syndrome: their disease- and organ-specificities

To test whether the autoantibodies reactive with epithelial cells of the salivary gland in sera from Sjögren's syndrome (SS) patients are specific for the organ and the disease, tissue reactivities of serum IgG obtained from the patients with SS and oral lichen planus (OLP), another immune-mediated oral mucosal disease, were examined by immunohistochemistry and Western blotting. IgG purified from the sera of SS patients specifically localized not only on the nuclei but also on the cytoplasm of the salivary gland epithelial cells. On the other hand, no convincing staining of the epithelial cells was observed when IgG purified from the sera of OLP patients or those from healthy controls were used for immunohistochemistry. No cytoplasmic staining was observed when sections of kidneys and pancreas were stained with SS patients'IgG. In Western blotting performed by using lysates of a submandibular gland as antigens, all the IgG prepared from the SS patients reacted prominently with several protein bands, including those specific for the disease and the organ. These results suggest that production of autoantibodies reacting with the cytoplasm of salivary gland epithelial cells is a characteristic of SS, and may play a role in the pathogenesis of the sialadenitis.