Sjögren Sendromu Ön Tanısı ile Minör Tükürük Bezi Biyopsisi Yapılan Hastalarda Biyopsi Sonuçlarıyla Serolojik Testlerin Karşılaştırılması.

Öz

Amaç: Sjögren sendromu egzokrin bezlerin lenfositik infiltrasyonu ile karakterize otoimmün inflamatuvar bir hastalıktır. Sjögren sendromu için çeşitli serolojik testler, semptomlar, histopatolojik bulguları içeren farklı sınıflandırma kriterleri bulunmaktadır. Bu çalışmada minör tükürük bezi biyopsi sonuçları ile serolojik özellikler arasındaki ilişkinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Minör tükürük bezi biyopsisi ile anti nükleer antikor, ekstrakte nükleer antijen, anti dense fine speckled 70 antikor sonuçları arasındaki ilişki değerlendirildi. İstatistiksel önemlilik için p< 0,05 ise anlamlı kabul edildi. Bulgular: Çalışmaya 77 hasta (71K, 6E) dahil edildi. Hastaların %22,1’inde anti nükleer antikor dense fine speckled paterndeydi. Hastaların %31,2’sinde biyopsi sonucu histopatolojik olarak kesin Sjögren sendromu ile uyumluydu (fokus skoru≥1). Hastaların %19,5’inde anti dense fine speckled 70 antikor, %26’sında anti SS-A antikor pozitifti. Anti dense fine speckled 70 antikor pozitifliği olan 15 hastanın 7’si Sjögren sendromu tanısı aldı. Anti dense fine speckled 70 antikor pozitif ve negatif hastalar arasında Sjögren sendromu tanısı açısından ve biyopsi pozitifliği açısından fark yoktu (p=0,905, p=0,996). Sonuç: Minör tükürük bezi biyopsisi Sjögren sendromu tanısında çok önemli bir yere sahiptir. Anti nükleer antikor, anti SS-A ve anti SS-B antikorları negatif olan hastalarda minör tükürük bezi biyopsisi Sjögren sendromu tanısı koyma şansı vermektedir. Tek başına anti dense fine speckled 70 antikor pozitifliği Sjögren sendromu tanısını dışlamamaktadır.

Anahtar Kelimeler

• Minör Tükürük Bezi Biyopsisi
• Sjögren Sendromu
• Anti Dense Fine Speckled Antikor

Comparison of the Minor Salivary Gland Biopsy Results and Serological Tests in Patients Performed Minor Salivary Gland Biopsy with Preliminary Diagnosis of Sjögren Syndrome.

Öz

Objective: Sjogren's syndrome is an autoimmune inflammatory disease characterized by lymphocytic infiltration of the exocrine glands. There are various classification criteria for Sjögren's syndrome which include various serological tests, symptoms, and histopathological findings. In this study, it was aimed to evaluate the relationship between minor salivary gland biopsy results and serological features. Material and Methods: The relationship between minor salivary gland biopsy and anti-nuclear antibody, extracted nuclear antigen, and the dense specled antibody results were evaluated. P <0.05 was considered significant. Results: 77 patients (71F, 6M) were included in the study. In 22.1% of the patients the anti-nuclear antibody was in a fine speckled pattern. The 31.2% of the patients was histopathologically compatible with Sjögren syndrome (focus score≥1). Anti dense fine speckled 70 antibody was positive in 19.5% of the patients and anti SS-A antibody in 26%. Seven of the 15 patients with anti dense fine speckled 70 antibody positivity were diagnosed with Sjögren's syndrome. There was no difference between anti dense fine speckled 70 antibody positive and negative patients in terms of diagnosis of Sjögren's syndrome and biopsy positivity (p = 0.905, p = 0.996). Conclusion: Minor salivary gland biopsy has very important place in diagnosis of Sjögren syndrome. Minor salivary gland biopsy gives the chance to diagnose Sjögren's syndrome in patients with negative anti nuclear antibodies, anti SS-A and anti SS-B antibodies. İsolated anti dense fine speckled 70 antibody positivity does not exclude Sjögren syndrome.

Anahtar Kelimeler

• Anti Dense Fine Speckled 70 Antibody
• Minor Salivary Gland Biopsy
• Sjögren

Kaynakça

1. 1. Aksoy T, Kiratli PO, Erbas B. Correlations between histopathologic and scintigraphic parameters of salivary glands in patients with Sjögren's syndrome.Clin Rheumatol 2012; Sep;31(9):1365-70.
2. 2. Thorne I, Sutcliffe N. Sjögren's syndrome Br J Hosp Med (Lond). 2017;78(8):438-42.
3. 3. Kessel A, Toubi E, Rozenbaum M, Zisman D, Sabo E, Rosner I. Sjögren's syndrome in the community: can serology replace salivary gland biopsy? Rheumatol Int 2006;26(4):337-9.
4. 4. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, Daniels TE, Fox PC, Fox RI, Kassan SS, Pillemer SR, Talal N, Weisman MH; Classification Criteria for Sjögren's Syndrome: A Revised Version of the European Criteria Proposed by the American-European Consensus Group European Study Group on Classification Criteria for Sjögren's Syndrome. Ann Rheum Dis 2002;61(6):554-8.
5. 5. Shiboski SC, Shiboski CH, Criswell L, Baer A, Challacombe S, et al Research Groups. American College of Rheumatology classification criteria for Sjögren's syndrome: a data-driven, expert consensus approach in the Sjögren's International Collaborative Clinical Alliance cohort Arthritis Care Res (Hoboken) 2012;64(4):475-87.
6. 6. Yazisiz V, Avci AB, Erbasan F, Kiriş E, Terzioğlu E. Diagnostic performance of minor salivary gland biopsy, serological and clinical data in Sjögren's syndrome: a retrospective analysis Rheumatol Int 2009 ;29(4):403-9.
7. 7. Chisholm DM, Mason DK: Labial salivary gland biopsy in Sjogren’s disease. Chisholm DM, Mason DK.J Clin Pathol 1968;21(5):656-60.
8. 8. Levent Kılıç, Umut Kalyoncu, İsmail Doğan, Bünyamin Kısacık1, Ömer Karadağ1, ismail Taşkıran Şule Apraş Bilgen, Ali Akdoğan1, Sedat Kiraz, İhsan Ertenli, Meral Çalgüneri Sjögren sendromu tanısında minör tükürük bezi biyopsisinin tekrarı gerekir mi? RAED Dergisi 2012;4(1):6-10.

9. 9. Mariz HA, Sato EI, Barbosa SH, Rodrigues SH, Dellavance A, Andrade LE. Pattern on the antinuclear antibody-HEp-2 test is a critical parameter for discriminating antinuclear antibody-positive healthy individuals and patients with autoimmune rheumatic diseases.Arthritis Rheum 2011 63(1):191-200.
10. 10. Watanabe A, Kodera M, Sugiura K, Usuda T, Tan EM, Takasaki Y, Tomita Y, Muro Y. Anti-DFS70 antibodies in 597 healthy hospital workers. Arthritis Rheum 2004;50(3):892-900.
11. 11. Lee H, Kim Y, Han K, Oh EJ. Application of anti-DFS70 antibody and specific autoantibody test algorithms to patients with the dense fine speckled pattern on HEp-2 cells. Scand J Rheumatol 2016;45(2):122-8.
12. 12. Muro Y, Sugiura K, Morita Y, Tomita Y. High concomitance of disease marker autoantibodies in anti-DFS70/LEDGF autoantibody-positive patients with autoimmune rheumatic disease. Lupus 2008;17(3):171-6.