Análise histológica retrospectiva de glândula salivar menor em pacientes com síndrome seca

• Autor(a) principal: Giovelli, Raquel Altoé
• Data de Publicação: 2013
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
• Texto Completo: http://repositorio.ufes.br/handle/10/5284
• topic: Labial salivary gland biopsy; Primary Sjӧgren’s Syndrome; American-European Consensus Group 2002 criteria; Biópsia de glândula salivar labial; Síndrome de Sjögren primária; Critérios para classificação diagnóstica do American-European Consensus Group 2002; Medicina; Glândulas salivares; Diagnóstico; Sjögren, Síndrome de; Biópsia; Fibromialgia; 61

Introduction/Objectives: In spite of the fact that Sjӧgren’s Syndrome (SS) is prevalent, it is still poorly diagnosed. Labial salivary gland biopsy (LSGB) is the most accurate diagnostic method but little performed in clinical practice, although it is part of the last 3 criteria for disease classification. The study of the accuracy of LSGB in a sample of clinical practice can help establish when recommending this procedure. Objectives: This study assessed the usefulness of LSGB for the diagnosis of primary SS studying the sensibility and specificity and the clinical profiles of patients who were referred to biopsy. Methods: Retrospective analysis of the anatomopathological reports from LSGB and medical report data from patients who underwent LSGB between 2008 and 2011. Results: Two-hundred ninety biopsies were performed during this period, and 74 were excluded due to insufficient clinical data. Of the remaining 216 patients, 0.46% (n=1) was carrier of the hepatitis C virus, 30.1% (n=65) had primary SS and 8.8% (n=19) secondary SS. In the sample, 94.3% (n=203) presented with sicca syndrome with 51.6% (n=111) only having dryness and 42.7% (n=92) having other associated symptoms; 66.9% (n=114) presented unstimulated salivary flow and/or reduced Schirmer test. Among the patients with lachrymal and/or salivary gland dysfunctions associated with positive anti-Ro/anti-La, 70% also showed LSGB compatible with SS and all of them met the American-European Consensus Group criteria 2002 (AEGC) for SS. The majority (85.1%, n=23) with no lachrymal or salivary dysfunctions, besides negative antibody, had LSGB with < 1 focus score and no one met the AEGC. The LSGB was necessary in 67.6% (n=44) in order to conclude the presence of SS based on AECG criteria. The sensibility and specificity of LSGB were 86.57% and 97.36%, respectively. Of the 98 patients referred with sicca syndrome and fibromyalgia, 36.75% (n=36) presented SS and LSBG ≥ 1 focus score. In comparison with individuals without SS, patients with SS were older, showed more severe lachrymal and salivary dysfunctions, greater frequency of fibromyalgia, anti-nuclear antibodies (ANA), anti-SSA-Ro, anti-SSA-La and further systemic manifestations. Among the patients with primary SS, 38,46% (n=25) showed extra glandular manifestations and 3% (n=2) had lymphoma. Conclusion: LSGB has a high sensibility and specificity and has contributed to the majority of cases for the diagnosis of SS. It is especially useful in patients with gland dysfunctions and negative antibodies. The frequency of SS confirmed by LSGB in patients with dryness symptoms and fibromyalgia is high and should be investigated in these patients.