IgG4相关唾液腺炎的临床病理特点及诊断
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摘要
<正>IgG4相关唾液腺炎(IgG4-related sialadenitis,IgG4-RS)是最近一些年才被认识的一类自身免疫性疾病,属于IgG4相关系统性疾病的一种,临床上表现为单个或多个唾液腺和(或)泪腺肿大,以往常误诊为肿瘤或慢性炎症行下颌下腺切除,导致唾液腺功能器官的丧失[1-3]。近10年来,本课题组对IgG4相关唾液腺炎的临床病理特点、诊断及鉴别诊断进行了较为系统的研究。
Immunoglobulin G4-related sialadenitis(IgG4-RS) is a newly recognized immune-mediated disease and one of immunoglobulin G4-related diseases(Ig G4-RD). Our multidisciplinary research group investigated the clinicopathological characteristics and diagnosis of IgG4-RS during the past 10 years.Clinically,it showed multiple bilateral enlargement of major salivary glands(including sublingual and accessory parotid glands) and lacrimal glands. The comorbid diseases of head and neck region including rhinosinusitis,allergic rhinitis,and lymphadenopathy were commonly seen,which could occur more early than enlargement of major salivary glands. Internal organ involvements,such as autoimmune pancreatitis,sclerosing cholangitis,and interstitial pneumonia could also be seen. Thirty-five(38. 5%) patients had the symptom of xerostomia. Saliva flow at rest was lower than normal. Secretory function was reduced more severely in the submandibular glands than in the parotid glands. Serum levels of IgG4 were elevated in almost all the cases and the majority of the patients had increased Ig E levels. CT,ultrasonography,and sialography showed their imaging characteristics. Histologically it showed marked lymphoplasmacytic inflammation,large irregular lymphoid follicles with expanded germinal centers,prominent cellular interlobular fibrosis,eosinophil infiltration,and obliterative phlebitis. Their immunohistological examination showed marked Ig G-positive and IgG4-positive plasma cell infiltration and high IgG4/IgG ratio. The disease could be divided into three stages according to severity of glandular fibrosis. The serum IgG4 level was higher and the saliva secretion lower as glandular fibrosis increased. IgG4-RS should be differentiated from other diseases with enlargement of major salivary gland and lacrimal gland,such as primary Sj9 gren syndrome,chronic obstructive submandibular sialadenitis,and eosinophilic hyperplastic lymphogranuloma.
Immunoglobulin G4-related sialadenitis(IgG4-RS) is a newly recognized immune-mediated disease and one of immunoglobulin G4-related diseases(Ig G4-RD). Our multidisciplinary research group investigated the clinicopathological characteristics and diagnosis of IgG4-RS during the past 10 years.Clinically,it showed multiple bilateral enlargement of major salivary glands(including sublingual and accessory parotid glands) and lacrimal glands. The comorbid diseases of head and neck region including rhinosinusitis,allergic rhinitis,and lymphadenopathy were commonly seen,which could occur more early than enlargement of major salivary glands. Internal organ involvements,such as autoimmune pancreatitis,sclerosing cholangitis,and interstitial pneumonia could also be seen. Thirty-five(38. 5%) patients had the symptom of xerostomia. Saliva flow at rest was lower than normal. Secretory function was reduced more severely in the submandibular glands than in the parotid glands. Serum levels of IgG4 were elevated in almost all the cases and the majority of the patients had increased Ig E levels. CT,ultrasonography,and sialography showed their imaging characteristics. Histologically it showed marked lymphoplasmacytic inflammation,large irregular lymphoid follicles with expanded germinal centers,prominent cellular interlobular fibrosis,eosinophil infiltration,and obliterative phlebitis. Their immunohistological examination showed marked Ig G-positive and IgG4-positive plasma cell infiltration and high IgG4/IgG ratio. The disease could be divided into three stages according to severity of glandular fibrosis. The serum IgG4 level was higher and the saliva secretion lower as glandular fibrosis increased. IgG4-RS should be differentiated from other diseases with enlargement of major salivary gland and lacrimal gland,such as primary Sj9 gren syndrome,chronic obstructive submandibular sialadenitis,and eosinophilic hyperplastic lymphogranuloma.
引文
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[2] Brito-Zeron P,Ramos-Casals M,Bosch X,et al. The clinical spectrum of Ig G4-related disease[J]. Autoimmun Rev,2014,13(12):1203-1210.
[3] Li W,Chen Y,Sun ZP,et al. Clinicopathological characteristics of immunoglobulin G4-related sialadenitis[J]. Arthritis Res Ther,2015,17(1):186-195.
[4] Hong X,Sun ZP,Li W,et al. Comorbid diseases of Ig G4-related sialadenitis in the head and neck region[J]. Laryngoscope,2015,125(9):2113-2118.
[5] Hong X,Li W,Su JZ,et al. Internal organ involvement in Ig G4-related sialadenitis:a systemic review[J]. Chin J Dent Res,2015,18(2):85-94.
[6]李巍,孙志鹏,刘筱菁,等.腮腺和颌下腺CT体积的测量[J].北京大学学报(医学版),2014,46(2):288-293.
[7] Li W,Xie XY,Su JZ,et al. Ultrasonographic features of immunoglobulin G4-related sialadenitis[J]. Ultrasound Med Biol,2016,42(1):167-175.
[8] Hong X,Li W,Xie XY,et al. Differential diagnosis of Ig G4-related sialadenitis,primary Sj9gren syndrome,and chronic obstructive submandibular sialadenitis[J]. Brit J Oral Maxillofac Surg,2017,55(1):179-184.
[9] Umehara H,Okazaki K,Masaki Y,et al. Comprehensive diagnostic criteria for Ig G4-related disease(Ig G4-RD),2011[J].Mod Rheumatol,2012,22(1):21-30.
[10] Seifert G. Sialadenitis[M]//Seifert G,Haubrich J. Diseases of thesalivary gland. New York:Thieme Inc.,1986:140-146.
[11] Khosroshahi A,Wallace ZS,Crowe JL,et al. International consensus guidance statement on the management and treatment of Ig G4-related disease. Arthr Rheumatol,2015,67(7):1688-1699.
[12] Yamamoto M,Yajima H,Takahashi H,et al. Everyday clinical practice in Ig G4-related dacryoadenitis and/or sialadenitis:results from the SMART database[J]. Mod Rheumatol,2015,25(2):199-204.
[13] Hong X,Zhang YY,Li W,et al. Treatment of immunoglobulin G4-related sialadenitis:outcomes of glucocorticoid therapy combined with steroid-sparing agents[J]. Arthritis Res Ther,2018,20(1):12-21.
[2] Brito-Zeron P,Ramos-Casals M,Bosch X,et al. The clinical spectrum of Ig G4-related disease[J]. Autoimmun Rev,2014,13(12):1203-1210.
[3] Li W,Chen Y,Sun ZP,et al. Clinicopathological characteristics of immunoglobulin G4-related sialadenitis[J]. Arthritis Res Ther,2015,17(1):186-195.
[4] Hong X,Sun ZP,Li W,et al. Comorbid diseases of Ig G4-related sialadenitis in the head and neck region[J]. Laryngoscope,2015,125(9):2113-2118.
[5] Hong X,Li W,Su JZ,et al. Internal organ involvement in Ig G4-related sialadenitis:a systemic review[J]. Chin J Dent Res,2015,18(2):85-94.
[6]李巍,孙志鹏,刘筱菁,等.腮腺和颌下腺CT体积的测量[J].北京大学学报(医学版),2014,46(2):288-293.
[7] Li W,Xie XY,Su JZ,et al. Ultrasonographic features of immunoglobulin G4-related sialadenitis[J]. Ultrasound Med Biol,2016,42(1):167-175.
[8] Hong X,Li W,Xie XY,et al. Differential diagnosis of Ig G4-related sialadenitis,primary Sj9gren syndrome,and chronic obstructive submandibular sialadenitis[J]. Brit J Oral Maxillofac Surg,2017,55(1):179-184.
[9] Umehara H,Okazaki K,Masaki Y,et al. Comprehensive diagnostic criteria for Ig G4-related disease(Ig G4-RD),2011[J].Mod Rheumatol,2012,22(1):21-30.
[10] Seifert G. Sialadenitis[M]//Seifert G,Haubrich J. Diseases of thesalivary gland. New York:Thieme Inc.,1986:140-146.
[11] Khosroshahi A,Wallace ZS,Crowe JL,et al. International consensus guidance statement on the management and treatment of Ig G4-related disease. Arthr Rheumatol,2015,67(7):1688-1699.
[12] Yamamoto M,Yajima H,Takahashi H,et al. Everyday clinical practice in Ig G4-related dacryoadenitis and/or sialadenitis:results from the SMART database[J]. Mod Rheumatol,2015,25(2):199-204.
[13] Hong X,Zhang YY,Li W,et al. Treatment of immunoglobulin G4-related sialadenitis:outcomes of glucocorticoid therapy combined with steroid-sparing agents[J]. Arthritis Res Ther,2018,20(1):12-21.