摘要
【目的】分析泪腺炎性病变的临床、血清学、影像学、病理特点,对给予的治疗措施进行研究,提高泪腺炎性病变的诊断及治疗效果。【方法】回顾性分析武警总医院眼眶病研究所2012年1月至2016年12月诊断为泪腺炎性病变患者261例,对其临床特征、血清学、病理诊断、影像学、治疗等方面分析疾病特点及随访观察疗效。【结果】261例病例以单侧或双侧泪腺区出现无痛性肿胀或肿物就诊,其中男性78例,女性183例。血清学检查,37例嗜酸性粒细胞升高,占14.17%;17例Ig E升高,占6.51%;26例Ig G升高,占9.96%;57例IgG4升高,占21.84%。眼部B超提示单侧或双侧泪腺体积增大,增大泪腺内中等偏低回声;CT或核磁共振检查显示:单侧或双侧泪腺体积增大,突出眶缘。CT中等密度,核磁T1WI中信号,T2WI高信号,增强后明显强化。261例患者给予药物或手术治疗:145例患者口服糖皮质激素,116例患者选择局部曲安奈德+地塞米松磷酸钠注射治疗。激素治疗效果欠佳的24例患者联合环磷酰胺免疫抑制剂治疗。治疗效果明显,表现为泪腺区肿胀明显缩小及血清IgG4浓度下降,影像学检查增大泪腺体积明显缩小。261例中78例患者泪腺炎性病变治疗后仍反复发作或不能耐受糖皮质激素治疗者,入院行单侧或双侧眶部泪腺切除手术。78例患者中,双侧眶部泪腺切除者23例,共收集病理标本101例。术后病理组织学检查结果:泪腺良性淋巴上皮病变23例,淋巴组织反应性增生37例,淋巴组织不典型增生12例,IgG4相关性泪腺炎28例。【结论】泪腺炎性病变临床表现以单侧或双侧泪腺区肿大,可伴有血清IgG4、Ig G、Ig E升高。影像学检查有助于诊断。糖皮质激素为泪腺炎性病变一线用药,治疗效果不好者可给予手术切除。病理学诊断有利于明确泪腺炎性病变分型。
【Objective】To analyze clinical, serological, imaging and pathological features of lacrimal gland inflammation and improve the diagnosis and treatment efficacy by studying the therapeutic measures given to the patients.【Methods】A total of 261 cases with lacrimal gland inflammation were retrospectively reviewed from January 2012 to December 2016 in Armed Police General Hospital. The clinical features and characteristics of serology, pathology, medical imageology and treatment were analyzed. The curative efficacy was followed up.【Results】The 261 patients suffered painless swelling or lump in unilateral or bilateral lacrimal gland area. There were 78 male patients and 183 female cases. The results of serology examination showed that 37 cases（14.17 %） suffered eosinophilia, Ig E level increased in 17 cases（6.51%）, Ig G level increased in 26 cases（9.96%）, and IgG4 level increased in 57 cases（21.84%）. The results of B ultrasound examination in eyes showed swelling appeared in unilateral or bilateral lacrimal gland area and B-ultrasound echo for swelling glands was medium low. Unilateral or bilateral lacrimal gland enlargement appeared in CT or MRI scan, which protruded orbital margin. Swelling area had medium signals in CT scan, medium signals in MRI T1 WI, high signals in MRI T2 WI. Signals were enhanced after enhancement. All the 261 cases were treated with medication or surgery. There were 45 cases treated with oral glucocorticoid and 116 cases with local injection of triamcinolone acetonide and dexmethasone sodium phosphate. The 24 cases with poor effect of glucocorticoid treatment were combined with immunosuppressive therapy of cyclophosphamide. The curative efficacy was obvious as follows： the swelling glands significantly decreased, IgG4 level decreased and enlarged glands significantly decreased in medical imaging examination. There were 78 patients suffered recurrent attacks or hormone intolerance who were admited to hospital for unilateral or bilateral orbital lacrimal gland remov
作者
李月月
王毅
杨新吉
黑砚
肖利华
纪星涉
LI Yue-yue;WANG Yi;YANG Xin-ji;HEI Yan;XlAO Li-hua;JI Xing-she(Department of Orbitopathy,General Hospital of PAP,Beijing 100039,China)
出处
《武警后勤学院学报（医学版）》
CAS
2017年第12期1052-1057,共6页
Journal of Logistics University of PAP（Medical Sciences）
关键词
泪腺炎性病变
淋巴上皮病变
淋巴组织反应性增生
IgG4相关性泪腺炎
Lacrimal gland inflammatiodisease
Lymphoepithelial lesions
Reactive hyperplasia of lymphoid tissues
IgG4-related lacrimal gland inflammation
