男女原发性干燥综合征的临床比较

    庄俊汉 张丽君 汪迅

    【摘 要】 目的 了解两性原发性干燥综合征(pSS)的临床特点 ,提高诊断治疗水平。方法 对

    77例pSS的临床资料进行统计分析。结果 两性间发病年龄和确诊时平均病程差异无显著性。临床

    上以口眼干燥为主诉就诊者不足一半 ,90 %以上存在高γ 2球蛋白血症。男性 pSS首发症状较女性多

    样化 ,以口眼干燥、关节疼痛、呼吸道症状、肾小管酸中毒及皮肤表现等较多见;口眼干燥症状出现较

    晚 ,发生率较低 ,症状较轻 ,但腮腺受损发生率与女性差异无显著性;而肺受累症状出现较早 ,肺间质

    纤维化发生率较高;类风湿因子(RF)及抗 SSA/ SSB 抗体阳性率较低。结论 pSS为全身性免疫性疾

    病 ,90 %以上病例存在高γ 2球蛋白血症。临床表现多样化 ,以口眼干燥为主诉就诊者不足半数;男性

    患者除临床表现与女性有较大差别外 ,自身抗体阳性率也较女性低。

    【关键词】 干燥综合征; 性别因素

    A comparison of clinical difference between male and female cases of primary Sj ê gren′ s syndrome

    ZHUANG Junhan , ZHANGLijun , WANG Xun. Xiangmihu Rheumatology Hospital , Branch of the Aff iliated Futian

    People′ s Hospital , Guangdong Medical College , Shenzhen 518033 ,China

    【Abstract】 Objective To understand the clinical features of primary Sjê gren′ s syndrome (pSS) in both

    sex ,thus to improve the level of diagnosis and treatment .Methods Clinical data of 77 cases of pSSwere collected

    and analyzed. Results No significant difference was found between male and female in mean age of onset and av 2

    erage disease duration at the time of diagnosis. Patients with dry mouth/ eye as a complaint for seeing a doctor ac 2

    counted for only less than a half ;whereas ,hyper 2 γ 2globulinemia existed in more than 90 %of the patients. The onset

    symptom in male was more different fromfemale. Dry mouth/ eye ,arthralgia ,pulmonary manifestations ,renal tubular

    acidosis ,and dermatic manifestations were the frequent presentations. Dry mouth/ eye presented latter ,uncommon ,and milder in male than in female. However ,no difference was found between male and female in the incidence of

    salivary gland involvement . Pulmonary symptoms presented earlier , and the incidence of pulmonary fibrosis was

    higher in male than in female.Whereas ,the pulmonary symptomoccurred earlier in male patients ,and the incidence

    of pulmonary interstitial fibrosis was higher in male than in female. The incidence of positive RF and anti 2SSA/ SSB

    antibody was significantly lower in male than in female.Conclusion Primary Sjê gren′ s syndrome is one of the sys 2

    temic immune diseases. It′ s clinical manifestations were diverse.Less than a half of patients see a doctor because of

    dry mouth/ eye. There are many differences between male and female patients in clinical presentations ;and the inci 2

    dence of positive auto2antibodies is lower in male patients than in female.

    【Key words】 Sjê gren′ s syndrome ; Sex factors

    原发性干燥综合征(primary Sjê gren′ s syndrome ,pSS)是一种慢性系统性自身免疫性疾病 ,表现为淋

    巴细胞和浆细胞对靶器官的进行性浸润 ,造成靶器

    官功能障碍。除主要累及泪腺及唾液腺以外 ,还可

    累及肾、肺、肝 ,以及血液、关节、皮肤等器官系统。

    pSS多见于中年女性 ,男∶女比例大约为 1∶ 9[1 ]

    ,男性

    患病率远低于女性。因此男性原发性干燥综合征易

    为 临 床 所 忽 略。为 探 讨 男 性 pSS 与 女

    性pSS的临床差异 ,对1994年以来在我院就诊的

    作者单位:518033 深圳,广东医学院附属福田人民医院香蜜湖风

    湿病分院

    77例pSS进行分析 ,结果如下。

    1 资料与方法

    111 病例选择:77 例 pSS 均为我院门诊及住院病

    人 ,经眼科、口腔科、风湿免疫科医生协助检查共同

    诊断 ,符合1996年董怡等[2 ]

    提出的pSS诊断标准。

    112 观察项目:包括一般资料、首发症状、临床表

    现:如口干、眼干燥 ———眼睛异物感或烧灼感、腮腺

    肿大、猖獗龋、关节肿痛、雷诺现象 ,以及肾、肺、肝、胰、肠、血液等器官、系统症状;腮腺造影、 Schirmer

    试验、角膜荧光染色、唾液自然流率等检查结果;实

    验室检查如尿 pH 值、 γ 2球蛋白水平、类风湿因子

    (RF) 、抗核抗体(ANA) 、抗 SSA/ SSB抗体等。

    113 实验方法:ANA 用 Hep22 细胞作底物 ,间接免

    · 334 · 中华风湿病学杂志2002年12月第6卷第6期 Chin J Rheumatol ,December 2002 ,Vol 6 ,No. 6

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