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目的探讨原发性干燥综合征(pSS)合并胃、肝脏及胰腺损害的特点及程度。方法分析152例pSS病例中合并胃、肝及胰腺损害的临床资料。结果pSS胃损害以慢性萎缩性胃炎(CAG)为常见(77.8%),发病年龄不同其萎缩区域亦不同,在萎缩程度与肠上皮化生方面明显轻于单纯CAG组,差异有显著性(P<0.05、P<0.01)。pSS合并肝损害的发病率为28.9%,重度肝损害发生率3.3%,pSS伴丙型肝炎病毒(HCV)感染发生率5.3%,且HCV阳性者抗SSA、抗SSB抗体阳性率极低,与不伴HCV感染的肝损害组差异有显著性(P<0.01)。pSS合并胰腺损害发生率8.6%,逆行胰管造影形态学表现为主胰管相对性狭窄。结论①pSS胃损害以CAG为常见,严重的黏膜萎缩或肠上皮化生很少见,患病年龄不同其萎缩区域亦不同。②pSS合并重度肝损害发生率3.3%,pSS伴HCV感染率为5.3%,感染HCV组抗SSA、SSB抗体阳性率极低。③逆行胰管造影主胰管相对性狭窄,这一形态学改变对诊断pSS合并胰腺损害具有一定的意义。
Objective To investigate the characteristics and degree of gastric, hepatic and pancreatic lesions in primary Sjogren’s syndrome (pSS). Methods Clinical data of 152 cases of pSS complicated with gastric, hepatic and pancreatic lesions were analyzed. Results The gastric lesions of pSS were common in patients with chronic atrophic gastritis (CAG) (77.8%). Their ages of onset varied from atrophy to pSS. The degree of atrophy and intestinal metaplasia were significantly lower than those of CAG alone (P <0.05, P <0.01). The incidence of pSS with hepatic impairment was 28.9%, the incidence of severe liver damage was 3.3%, the incidence of pSS with HCV infection was 5.3%, and the positive rates of anti-SSA and anti-SSB antibodies of HCV-positive patients were very low. There was a significant difference between the groups of liver damage without HCV infection (P <0.01). The incidence of pSS complicated with pancreatic lesions was 8.6%. The retrograde pancreatic duct angiography showed the relative stenosis of the main pancreatic duct. Conclusion ① PSS gastric lesions with CAG as a common, severe mucosal atrophy or intestinal metaplasia is rare, the age of onset of different areas of its atrophy are also different. The incidence of severe hepatic injury was 3.3% in pSS group and 5.3% in pSS group. The positive rate of anti-SSA and SSB antibody in HCV group was very low. ③ retrograde pancreatic ductus arteriosus pancreatic duct relative stenosis, the morphological changes in the diagnosis of pSS with pancreatic injury has a certain significance.