口眼干及腮腺肿大的鉴别诊断是否为干燥综合症
发表者： 金银姬
日期：2015-02-27
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摘要：原发性干燥综合征是常见的自身免疫病，绝大部分患者表现为口眼干，约一半患者有腮腺肿胀或腺外表现，5%~10%的患者可发展为淋巴瘤。然而，很多其他疾病也可以干燥或唾液腺肿大为主要表现，这就需行鉴别诊断和随访。临床上常遇到眼口干的患者，且随年龄的增大而多见。当评估患者是否患原发性干燥综合征时，第一步是需除外其他疾病。临床医生可通过正常和异常泪腺及唾液腺的生理状况评估其功能和结构，来进一步诊断。近年来，有一些新方法如眼表染色评分或唾液腺超声可评估腮腺及唾液腺。我们对240例可疑原发性干燥综合征的患者进行了单中心队列研究，结果发现，最常见的诊断为原发性干燥综合征、其他自身免疫病、特发性干燥综合征及药物相关性干燥综合征。然而，由于治疗不同，需要除外的其他疾病包括结节病、肉芽肿性小血管炎、IgG4相关性疾病、慢性丙肝或艾滋病、移植物抗宿主病及头颈部放疗等。
附原文：Abstract Primary Sjögren's syndrome (pSS) is a frequent autoimmune systemic disease, clinically characterized by eyes and mouth dryness in all patients, salivary gland swelling or extraglandular systemic manifestations in half of the patients, and development of lymphoma in 5 to 10 % of the patients. However, patients presenting with sicca symptoms or salivary gland swelling may have a variety of conditions that may require very different investigations, treatments, or follow-up. Eye and/or mouth dryness is a frequent complaint in clinical setting, and its frequency increases with age. When evaluating a patient with suspected pSS, the first step is to rule out its differential diagnoses, before looking for positive arguments for the disease. Knowledge of normal and abnormal lachrymal and salivary gland physiology allows the clinician to prescribe the most adapted procedures for evaluating their function and structure. New tests have been developed in recent years for evaluating these patients, notably new ocular surface staining scores or salivary gland ultrasonography. We describe the different diagnoses performed in our monocentric cohort of 240 patients with suspected pSS. The most frequent diagnoses are pSS, other systemic autoimmune diseases, idiopathic sicca syndrome and drug-induced siccasyndrome. However, other diseases are important to rule out due to their specific management, such as sarcoidosis, granulomatosis with polyangeitis, IgG4-related disease, chronic hepatitis C virus or human immunodeficiency virus infections, graft-versus-host disease, and head and neck radiation therapy. At the light of these data, we propose a core of minimal investigations to be performed when evaluating a patient with suspected pSS.
引自：Cornec D1, Saraux A, Jousse-Joulin S, et al. The Differential Diagnosis of Dry Eyes, Dry Mouth, and Parotidomegaly: A Comprehensive Review. Clin Rev Allergy Immunol. 2014 Jun 21. [Epub ahead of print] （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）
附原文：Abstract Primary Sjögren's syndrome (pSS) is a frequent autoimmune systemic disease, clinically characterized by eyes and mouth dryness in all patients, salivary gland swelling or extraglandular systemic manifestations in half of the patients, and development of lymphoma in 5 to 10 % of the patients. However, patients presenting with sicca symptoms or salivary gland swelling may have a variety of conditions that may require very different investigations, treatments, or follow-up. Eye and/or mouth dryness is a frequent complaint in clinical setting, and its frequency increases with age. When evaluating a patient with suspected pSS, the first step is to rule out its differential diagnoses, before looking for positive arguments for the disease. Knowledge of normal and abnormal lachrymal and salivary gland physiology allows the clinician to prescribe the most adapted procedures for evaluating their function and structure. New tests have been developed in recent years for evaluating these patients, notably new ocular surface staining scores or salivary gland ultrasonography. We describe the different diagnoses performed in our monocentric cohort of 240 patients with suspected pSS. The most frequent diagnoses are pSS, other systemic autoimmune diseases, idiopathic sicca syndrome and drug-induced siccasyndrome. However, other diseases are important to rule out due to their specific management, such as sarcoidosis, granulomatosis with polyangeitis, IgG4-related disease, chronic hepatitis C virus or human immunodeficiency virus infections, graft-versus-host disease, and head and neck radiation therapy. At the light of these data, we propose a core of minimal investigations to be performed when evaluating a patient with suspected pSS.
引自：Cornec D1, Saraux A, Jousse-Joulin S, et al. The Differential Diagnosis of Dry Eyes, Dry Mouth, and Parotidomegaly: A Comprehensive Review. Clin Rev Allergy Immunol. 2014 Jun 21. [Epub ahead of print] （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）