Email Alert | RSS

北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (1): 1-3. doi: 10.19723/j.issn.1671-167X.2019.01.001

• 工作综述 •    下一篇

IgG4相关唾液腺炎的临床病理特点及诊断

俞光岩1,2,△(),洪霞1,2,李巍1,张严妍1,高岩3,陈艳3,张祖燕4,谢晓艳4,栗占国5,刘燕鹰5,苏家增1,朱文瑄1,孙志鹏4   

  1. 1. 北京大学口腔医学院·口腔医院, 口腔颌面外科 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室, 北京 100081
    2. 北京大学深圳医院口腔医学中心, 广东深圳 518036
    3. 北京大学口腔医学院·口腔医院 口腔病理科, 北京　100081
    4. 北京大学口腔医学院·口腔医院 口腔放射科, 北京　100081
    5. 北京大学人民医院风湿免疫科, 北京 100044
  • 收稿日期:2018-11-26 出版日期:2019-02-18 发布日期:2019-02-26
  • 通讯作者: 俞光岩 E-mail:gyyu@263.net
  • 基金资助:
    国家自然科学基金(81470756);国家自然科学基金(81671005);国家自然科学基金(81611540351)

Clinicopathological characteristics and diagnosis of IgG4-related sialadenitis

Guang-ya YU1,2,△(),Xia HONG1,2,Wei LI1,Yan-yan ZHANG1,Yan GAO3,Yan CHEN3,Zu-yan ZHANG4,Xiao-yan XIE4,Zhan-guo LI5,Yan-ying LIU5,Jia-zeng SU1,Wen-xuan ZHU1,Zhi-peng SUN4   

  1. 1. Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Center of Stomatology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
    3. Department of Oral Pathology, Peking University School and Hospital of Stoma-tology, Beijing 100081, China
    4. Department of Oral Radiology, Peking University School and Hospital of Stoma-tology, Beijing 100081, China
    5. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, 100044, China
  • Received:2018-11-26 Online:2019-02-18 Published:2019-02-26
  • Contact: Guang-ya YU E-mail:gyyu@263.net
  • Supported by:
    Supported by the National Natural Science Foundation of China(81470756);Supported by the National Natural Science Foundation of China(81671005);Supported by the National Natural Science Foundation of China(81611540351)

RICH HTML

 62   

PDF (PC)

594

关键词: IgG4相关唾液腺炎, IgG4相关病, 唾液腺, 下颌下腺, 腮腺, 泪腺

Abstract:

SUMMARY Immunoglobulin G4-related sialadenitis (IgG4-RS) is a newly recognized immune-mediated disease and one of immunoglobulin G4-related diseases (IgG4-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 IgE 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 IgG-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 Sjögren syndrome, chronic obstructive submandibular sialadenitis, and eosinophilic hyperplastic lymphogranuloma.

Key words: IgG4-related sialadentitis, IgG4-related disease, Salivary gland, Submandibular gland, Parotid gland, Lacrimal gland

中图分类号: 

  • R780.2
[1] Geyer JT, Deshpande V . IgG4-associated sialadenitis[J]. Curr Opin Rheumatol, 2011,23(1):95-101.
doi: 10.1097/BOR.0b013e3283413011
[2] Brito-Zeron P, Ramos-Casals M, Bosch X , et al. The clinical spectrum of IgG4-related disease[J]. Autoimmun Rev, 2014,13(12):1203-1210.
doi: 10.1016/j.autrev.2014.08.013 pmid: 25151972
[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.
doi: 10.1186/s13075-015-0698-y pmid: 4508811
[4] Hong X, Sun ZP, Li W , et al. Comorbid diseases of IgG4-related sialadenitis in the head and neck region[J]. Laryngoscope, 2015,125(9):2113-2118.
doi: 10.1002/lary.25387 pmid: 25994602
[5] Hong X, Li W, Su JZ , et al. Internal organ involvement in IgG4-related sialadenitis: a systemic review[J]. Chin J Dent Res, 2015,18(2):85-94.
pmid: 26167546
[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.
doi: 10.3969/j.issn.1671-167X.2014.02.022
[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.
doi: 10.1016/j.ultrasmedbio.2015.09.014 pmid: 26518180
[8] Hong X, Li W, Xie XY , et al. Differential diagnosis of IgG4-related sialadenitis, primary Sjögren syndrome, and chronic obstructive submandibular sialadenitis[J]. Brit J Oral Maxillofac Surg, 2017,55(1):179-184.
doi: 10.1016/j.bjoms.2016.10.021 pmid: 27866757
[9] Umehara H, Okazaki K, Masaki Y , et al. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011[J]. Mod Rheumatol, 2012,22(1):21-30.
doi: 10.3109/s10165-011-0571-z
[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 IgG4-related disease. Arthr Rheumatol, 2015,67(7):1688-1699.
doi: 10.1002/art.39132 pmid: 25809420
[12] Yamamoto M, Yajima H, Takahashi H , et al. Everyday clinical practice in IgG4-related dacryoadenitis and/or sialadenitis: results from the SMART database[J]. Mod Rheumatol, 2015,25(2):199-204.
doi: 10.3109/14397595.2014.950036 pmid: 25159154
[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.
doi: 10.1186/s13075-017-1507-6 pmid: 29382364
[1] 俞光岩,柳登高,李巍,洪霞,张严妍,朱文瑄,张可夫,李潇,栗占国,刘燕鹰,陈艳,高岩,苏家增. 3类新型慢性唾液腺炎的诊断和治疗[J]. 北京大学学报（医学版）, 2022, 54(1): 13-17.
[2] 陈超伦,苏家增,俞光岩. 酸刺激对腮腺和下颌下腺唾液流率及成分的影响[J]. 北京大学学报（医学版）, 2022, 54(1): 89-94.
[3] 朱忆颖,闵赛南,俞光岩. 局部注射环孢素A对非肥胖糖尿病小鼠下颌下腺分泌功能及炎症的影响[J]. 北京大学学报（医学版）, 2021, 53(4): 750-757.
[4] 王怡平,蔡志刚,彭歆,张杰,孙志鹏,李巍,张雷,俞光岩. 下颌下腺质量和体积的实体体外检测[J]. 北京大学学报（医学版）, 2021, 53(1): 126-132.
[5] 俞光岩. 多发性唾液腺肿大的鉴别诊断及处理[J]. 北京大学学报（医学版）, 2021, 53(1): 1-4.
[6] 李潇,苏家增,张严妍,张丽琪,张亚琼,柳登高,俞光岩. 131I相关唾液腺炎的炎症分级及内镜治疗[J]. 北京大学学报（医学版）, 2020, 52(3): 586-590.
[7] 李玉冰,孙丽莎,孙志鹏,谢晓艳,张建运,张祖燕,赵燕平,马绪臣. 腮腺CT影像报告与数据系统的初步研究[J]. 北京大学学报（医学版）, 2020, 52(1): 83-89.
[8] 张晔,张妮,刘晓筱,周传香. 唾液腺腺样囊性癌淋巴结转移相关的临床病理分析[J]. 北京大学学报（医学版）, 2020, 52(1): 30-34.
[9] 丛馨,闵赛南,吴立玲,蔡志刚,俞光岩. 激活毒蕈碱乙酰胆碱受体调控下颌下腺分泌的机制研究[J]. 北京大学学报（医学版）, 2019, 51(3): 390-396.
[10] 宿骞,彭歆,周传香,俞光岩. 原发性腮腺淋巴瘤的临床病理特点及预后分析[J]. 北京大学学报（医学版）, 2019, 51(1): 35-42.
[11] 俞光岩，吴立玲，蔡志刚，吕岚，丛馨. 血管化自体下颌下腺移植治疗重症干眼20年研究[J]. 北京大学学报(医学版), 2018, 50(1): 1-4.
[12] 高敏, 陈艳, 康艳凤, 彭歆俞光岩. 面神经电图预测腮腺肿瘤患者的面神经受侵状态[J]. 北京大学学报（医学版）, 2015, 47(1): 57-61.
[13] 李巍, 孙志鹏, 刘筱菁, 俞光岩. 腮腺和颌下腺体积的测量[J]. 北京大学学报（医学版）, 2014, 46(2): 288-293.
[14] 单小峰，林博，卢旭光，蔡志刚，俞光岩. 腮腺手术中面神经监护的应用[J]. 北京大学学报（医学版）, 2014, 46(1): 48-52.
[15] 赵坚，张雷，柳登高，张祖燕，俞光岩. 涎腺内镜辅助手术取石治疗腮腺涎石症[J]. 北京大学学报（医学版）, 2014, 46(1): 39-42.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究（英文稿）[J]. 北京大学学报（医学版）, 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报（医学版）, 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报（医学版）, 2009, 41(2): 135 -140 .
[4] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报（医学版）, 2009, 41(2): 158 -161 .
[5] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报（医学版）, 2009, 41(2): 217 -220 .
[6] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报（医学版）, 2009, 41(1): 52 -55 .
[7] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报（医学版）, 2009, 41(1): 109 -111 .
[8] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报（医学版）, 2009, 41(3): 297 -301 .
[9] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报（医学版）, 2009, 41(5): 599 -601 .
[10] 李伟军, 邢晓芳, 曲立科, 孟麟, 寿成超. PRL-3基因C104S位点突变体和CAAX缺失体的构建及表达[J]. 北京大学学报（医学版）, 2009, 41(5): 516 -520 .
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部