544 例慢性唾液腺炎的临床与影像学特点及病因分析

Clinical and imaging characteristics and etiology of 544 cases with chronic sialadenitis

摘要

目的：探索临床上常见的几类不同病因导致的慢性唾液腺炎的占比，并分析其临床和影像学特点。方法：回顾性分析2021年1月至2023年8月就诊于北京大学口腔医院并行唾液腺内镜治疗的各类慢性唾液腺炎患者的临床及影像资料，除外干燥综合征伴感染、IgG4相关唾液腺炎、结石病伴感染等，根据现有研究结果和资料，初步将唾液腺炎分为  ¹³¹ I 相关唾液腺炎、过敏相关唾液腺炎、成人复发性腮腺炎、腮腺良性肥大伴管炎、原发性导管狭窄性唾液腺炎（指未发现目前已知的可能病因，并存在导管狭窄的慢性唾液腺炎），统计分析各类慢性唾液腺炎的占比和主要临床、影像学特点。结果：共纳入 544 例患者，男性 192 例、女性 352 例，平均年龄（47.44±13.52）岁（14~83 岁）。其中，原发性导管狭窄性唾液腺炎最多，占 71.7％（390例）；过敏相关唾液腺炎次之，占12.5％（68例）； ¹³¹I 相关唾液腺炎占 6.4%（35 例），成人复发性腮腺炎占 4.8%（26 例），腮腺良性肥大伴管炎占 4.6%（25例）。 544 例患者共 1120 侧腺体受累，包括腮腺 880 侧（78.6%）及下领下腺 240 侧（21.4%）。这五类唾液腺炎在性别、年龄、受累腺体类别、受累腺体数目及病程上差异均存在统计学意义（P<0.05）， ¹³¹I 相关唾液腺炎患者的女性占比最高（男：女=1：4.83），成人复发性腮腺炎患者的平均年龄最小[（32.50±8.60）岁]， ¹³¹ I 相关唾液腺炎和过敏相关唾液腺炎的受累腺体数目相对较多。从造影表现看， ¹³¹I 相关唾液腺炎中 23.2% 的受累腺体发生导管闭锁，过敏相关唾液腺炎中 46.5％的受累腺体分支导管呈＂雪花样＂扩张表现，成人复发性腮腺炎中 80.4％的受累腺体可见末梢导管＂点球状扩张＂，腮腺良性肥大伴管炎的受累腺体分支导管呈丛簇状表现者占 71.4% ，原发性导管狭窄性唾液腺炎的造影表现以主导管（主导管和分支导管）狭窄和（或）扩张为主。结论：原发性导管狭窄性唾液腺炎、  ¹³¹ I 相关唾液腺炎、过敏相关唾液腺炎、成人复发性腮腺炎、腮腺良性肥大伴管炎是临床上常见的五类慢性唾液腺炎，其中原发性导管狭窄性唾液腺炎占比最大。明确各类慢性唾液腺炎的病因、临床及影像学特征，将有利于临床医师制定个性化治疗方案，改善治疗效果。

Abstract

Objective：To investigate the etiology of chronic sialadenitis，and to analyze their clinical and imaging characteristics. Methods：This retrospective analysis reviewed the clinical and imaging data of patients with chronic sialadenitis who underwent sialendoscopy at the Peking University Hospital of Sto- matology between January 2021 and August 2023.Inclusion criteria：（1）with a history of recurrent swelling of major salivary glands；（2）complete medical records with detailed information about potential causes；（3）sialography images were available；and（4）patients had undergone interventional endosco- py.Exclusion criteria：（1）salivary stones；（2）juvenile recurrent parotitis；（3）IgG4-related sialadeni- tis；（4）Sjögren syndrome；and（5）neoplastic diseases.Based on the latest research results and clinical data，chronic sialadenitis was classified into radioactive iodine-induced sialadenitis（RAIS），allergy- related sialodochitis（ARS），adult chronic recurrent parotitis（ACRP），sialadenosis with sialodochitis ， and idiopathic sialadenitis.Idiopathic sialadenitis was defined as a type of chronic sialadenitis with duct stenosis of unknown etiology（allergic causes ，autoimmune disorders ，radioactive iodine exposure ，history of＂parotitis＂in childhood，etc.）.The proportions of five types of sialadenitis were calculated，and their relationships with age，gender，type of affected glands，number of affected glands，duration of symptoms， and imaging characteristics were statistically analyzed. Results：A total of 544 consecutive patients diag- nosed with chronic sialadenitis were enrolled in this study.They consisted of 192 males and 352 females， and their ages ranged from 14 to 83 years[mean age：(47.44±13.52) years].Idiopathic sialadenitis accounted for the largest proportion（71.7％， 390 cases），followed by ARS（12.5％， 68 cases），RAIS （6.4%,35 cases），ACRP（4.8%,26 cases），and sialadenosis with sialodochitis（4.6%,25 cases）. Among the 2176 available glands of the 544 patients， 1120 （51.5％）glands were affected，including 880 （78.6％）parotid glands and 240 （21.4％）submandibular glands.These five types of sialadenitis exhibited significant differences in gender，age，type and number of affected glands，and duration of symptoms (P<0.05).Among them，RAIS patients showed the lowest male to female ratio（male ：fe- male =1:4.83) ，ARCP patients were the youngest $\left[\right(32.50\pm 8.60)$ years]，and RAIS and ARS pa- tients had relatively higher number of affected glands.Sialography showed ductal atresia in 23.2％of af- fected glands with ARIS，＂snowflake＂pattern in 46.5％of affected glands with ARS，＂punctate and globular＂ectasia of terminal ducts in 80.4％of affected glands with ARCP，and clustered branch ducts in 71.4％of affected glands with sialadenosis with sialodochitis.Moreover，stenosis and/or dilatation of the main and branch ducts represented the most typical sialography appearance of idiopathic sialadenitis. Conclusion：Idiopathic sialadenitis，RAIS，ARS，ACRP，and sialadenosis with sialodochitis are the five common types of chronic sialadenitis.Among these，idiopathic sialadenitis is the most common type of chronic sialadenitis.Clarification of the etiology，clinical manifestations and imaging characteristics of chronic sialadenitis is important for clinicians to develop personalized treatment plans and improve treat- ment outcomes.

关键词

唾液腺炎 / 碘放射性同位素 / 超敏反应 / 腮腺 / 下领下腺

Key words

Sialadenitis / Iodine radioisotopes / Hypersensitivities / Parotid gland / Submandibular gland

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