3类新型慢性唾液腺炎的诊断和治疗

doi:10.19723/j.issn.1671-167X.2022.01.003

北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (1): 13-17. doi: 10.19723/j.issn.1671-167X.2022.01.003

3类新型慢性唾液腺炎的诊断和治疗

俞光岩^1,^2,^△(),柳登高³,李巍¹,洪霞^1,²,张严妍¹,朱文瑄¹,张可夫¹,李潇¹,栗占国⁴,刘燕鹰⁵,陈艳⁶,高岩⁶,苏家增¹

1.北京大学口腔医学院·口腔医院口腔颌面外科,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·口腔医院口腔放射科,北京 100081
4.北京大学人民医院风湿免疫科, 北京 100044
5.首都医科大学附属北京友谊医院风湿免疫科,北京 100050
6.北京大学口腔医学院·口腔医院口腔病理科, 国家口腔医学中心,国家口腔疾病临床医学研究中心,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

收稿日期:2021-09-13 出版日期:2022-02-18 发布日期:2022-02-21
通讯作者: 俞光岩 E-mail:gyyu@263.net
基金资助:
国家自然科学基金(82081240420);国家自然科学基金(81974151);国家自然科学基金(81671005);国家自然科学基金(81470756);国家自然科学基金(81611540351)

Studies on newly recognized chronic sialadenitis

YU Guang-yan^1,^2,^△(),LIU Deng-gao³,LI Wei¹,HONG Xia^1,²,ZHANG Yan-yan¹,ZHU Wen-xuan¹,ZHANG Ke-fu¹,LI Xiao¹,LI Zhan-guo⁴,LIU Yan-ying⁵,CHEN Yan⁶,GAO Yan⁶,SU Jia-zeng¹

1. Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
2. Center of Stomatology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
3. Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing 100081, China
4. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, 100044, China
5. Department of Rheumatology and Immunology, Capital Medical University Affiliated Beijing Friendship Hospital, 100050, China
6. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key laboratory of Digital Stomatology, Beijing 100081, China

Received:2021-09-13 Online:2022-02-18 Published:2022-02-21
Contact: Guang-yan YU E-mail:gyyu@263.net
Supported by:
National Natural Science Foundation of China(82081240420);National Natural Science Foundation of China(81974151);National Natural Science Foundation of China(81671005);National Natural Science Foundation of China(81470756);National Natural Science Foundation of China(81611540351)

摘要/Abstract

Abstract:

Some kinds of chronic sialadenitis were recognized during the recent years. They have specific pathogenesis, clinical and histopathologic appearances, and require specific treatment. IgG4-related sialadenitis (IgG4-RS) is one of the immune-mediated diseases, characterized by tumefactive lesions. The incidence of IgG4-RS obviously increased during the past 30 years. The study on the potential relationship between occupational exposure to chemical substances and the incidence of IgG4-RS showed that subjects with occupational exposure to agents known to cause IgG4-RD had an increased risk for IgG4-RS. Surgical excision of involved SMG could not control the disease progression, which is not recommended for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents is effective for treating IgG4-RS, and restores salivary gland function. Radioiodine induced sialadenitis (RAIS) is one of the common complications of postoperative adjuvant treatment of differentiated thyroid cancer by ¹³¹I. The incidence of the disease is related to radiation dosage. Clinically, the patients suffered from swelling and tenderness in the buccal or submandibular regions, especially during the mealtime. Imaging appearances are similar to those of chronic obstructive sialadenitis. Conservative managements, such as gland massage, sialagogues, are the mainstream methods in the treatment of RAIS. Sialendoscopy is feasible for RAIS, but not as effective as conventional obstructive sialadenitis (COS). Therefore the prevention of RAIS is crucial. Eosinophilic sialodochitis (ES) is a new type of chronic inflammatory disease of the salivary gland related to allergy. It has characteristics of swelling of multiple major salivary glands, strip-like gelatinous plugs discharged from the duct orifice of the gland,elevated level of serum IgE and eosinophils in peripheral blood, infiltration of eosinophils and IgE positive plasma cells in the tissues,allergic history, increased expression of allergy-related cytokines, such as IL-4,IL-5,IL-13, and eotaxin, which suggest allergic reactions as a potential pathogenesis of the disease. The clinical, laboratory, histological, and immunohistochemical characteristics of ES are significantly different from conventional obstructive sialadenitis (COS). Therefore, it is suitable to separate ES from COS. Conservative managements, such as self-maintenance therapy and anti- allergic modality are the choices of treatment for ES. Based on the results of our comprehensive studies a new classification of chronic sialadenitis is suggested.

Key words: IgG4-related sialadenitis, Radioactive iodine-induced sialadenitis, Eosinophilic sialodochitis, Salivary gland, Submandibular gland, Parotid gland

中图分类号:

R782.3

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.

YU Guang-yan,LIU Deng-gao,LI Wei,HONG Xia,ZHANG Yan-yan,ZHU Wen-xuan,ZHANG Ke-fu,LI Xiao,LI Zhan-guo,LIU Yan-ying,CHEN Yan,GAO Yan,SU Jia-zeng. Studies on newly recognized chronic sialadenitis[J]. Journal of Peking University (Health Sciences), 2022, 54(1): 13-17.

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3类新型慢性唾液腺炎的诊断和治疗

Studies on newly recognized chronic sialadenitis

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