| Objective:To investigate hospitalized patients with Sjogren's syndrome met the 2002 American-European Classification criteria for Sjogren's syndrome.To understand the similarities and differences of the involvement of various systems between Primary Sjogren's Syndrome(pSS) patients in our hospital and pSS of domestic and foreign literature. To analyse the similarities and differences of the clinical features and laboratory tests between pSS and secondary Sjogren's syndrome (sSS) patients. Furthermore, to improve the rate of diagnosis accuracy for Sjogren's syndrome in the future. To detect the expression of, SSA, SSB and SS56 protein in the labial salivary glands of 41 SS patients, compare the expression of SSA and SSB in the serum and labial glands, analyse the similarities and differences of the clinical features and laboratory tests between SS56 negative group and positive group, explore SSA60, SSB and SS56 protein in SS pathogenesis and diagnostic significance.Method:(1)Hospitalized patients with Sjogren's syndrome in 2003.1.1-2009.2.28 in in-patient department of our hospital were enrolled. Record cases of the general situation, the clinical features, laboratory examination and related autoantibodies. In according to 2002 international diagnostic criteria for Sjogren's syndrome, the patients were divided into pSS group and sSS group. (2) Immunohistochemistry (streptavidin-perosidase, SP) was used to detect the expression of SSA60, SSB and SS56 in the specimens of labial gland of 30 cases of primary SS,11 cases of secondary SS (sSS), and 5 cases of controls. With cell cytoplasm, nuclei and/or cell membrane appeared weak yellow to tan fine granular material, shading above background impression was positive. Record and analyse the clinical manifestations and laboratory tests of 41 cases SS patients.Results:The first part (1) General condition:A total of 75 patients with Sjogren's syndrome patients were enrolled,3males and 72 females, and male to female ratio was 1:24. The youngest is 15 years old, while the oldest is 72 years, with an average age of 51.03±14.12 years. pSS group of 59 patients, which the male to female ratio was 1:18.7 and the average age was 50.63±13.84 years. sSS group included 16 female cases, which secondary to SLE 9 cases,RA 6 cases,PM 1 case, the average age was 52.5±15.48 years. One case had a family history, whose mother has been suffering from SLE. (2) Initial symptoms:25 cases(33.3%) with dry mouth and dry eryes,16 cases(21.3%) with arthralgia,10 patients (13.3%) with blood system involvement,7 patients(9.3%) with fever,5 cases(6.7%) with skin involvement,5 cases(6.7%) with parotitis,4 case(5.3%) with renal involvement,2 cases(2.7%) with respiratory system involvementin,1 case(1.3%) with binocular vision decrease. (3) 59 pSS cases clinical manifestations and main laboratory tests:The clinical manifestations of pSS group were various. Among the 59 patients, there were 57 patients with dry mouth (96.6%),52 cases(88.1%) with dry eyes,7 cases (11.9%) with dry nose,14 cases (23.7%) with fever,10 patients (16.9%) with swollen lymph nodes,31 cases (52.5%) with rampant dental caries,21(35.6%) cases with mucocutaneous involvement; 31 cases (52.5%) with arthralgia,13 cases (22.0%) with fatigue,13cases (22.0%) with parotitis,40 cases (67.8%) with blood system involvement; 11 cases (18.6%) with spleen enlargement; 15 cases (25.4%) with renal involvement; 32 cases (54.2%) with Lung involvement,12 patients (20.3%) with liver damage and 4 cases with venous thrombosis, one patient had complete transposition of internal organs. The main laboratory tests were listed as follow:Corneal staining (+) 33/50 (84.7%), parotid scanning 47/53 (89.8%), labial gland biopsy 50/54 (91.5%), 22 cases of leukopenia (37.3%), anemia in 18 cases (30.5%), thrombocytopenia in 6 patients (10.2%), elevated erythrocyte sedimentation rate (ESR) in 49 cases (83.1%), increasing CRP in 16 patients (27.1%), decreasing albumin in 17 patients (28.8%), increasing globulin in 37 cases (62.7%), SSA60 (+) (83.1%), SS52 (+) (67.8%), SSB (+) (50.8%), RF (+) 24/37 (64.9%). Antinuclear antibodies were positive, the main type of which was spot and titer was 1:320 majority. (4)pSS and sSS clinical features and laboratory Comparison:While 59 cases of pSS were compared with 16 cases sSS, the difference of dry mouth, dry eyes, fatigue, enlarged spleen, swollen lymph nodes, blood system involvement, liver damage, kidney involvement, etc between the two groups had no statistical significance (P> 0.05). However, the difference of the positive rate of joint pain (52.5% vs87.5%) and dental caries (52.5% vsl8.8%) between the two groups had statistical significance (P<0.05). The difference of blood count, ESR faster, globulin, antinuclear antibodies, anti-SSA antibodies, anti-SSB antibodies, antinuclear antibody titers, etc had had no statistical significance (P> 0.05), but sSS group differences in albumin decreasing compared with pSS group was more significant (P<0.05). The second part (1) SSA in SS patients lip gland ductal epithelial cells (DEC) and acinar cells epithelial cells (AEC) positively expressed, a little infiltration of lymphocytes also positively expressed; SSB and SS56 not only positive expression in SS patients AEC, DEC, lip glands in mass also expressed the infiltration of lymphocytes. (2) SSA, SSB and SS56 in pSS and sSS two groups of the patient's labial salivary glands expressed no significant difference (P> 0.05). (3) SSA, SSB and SS56 in the SS patients and normal control group of the patient's labial salivary glands expressed no significant difference (P> 0.05). (4) SSA comparing to SSB and SS56 expressed comparative differences with a statistical significance (P<0.05), there was no statistical significance between SSB and SS56 (P> 0.05). (5) SSA, SSB positive expression in serum and the labial glands were statistically significant comparative difference (P＜0.05). SSA highly expressed in serum, and SSB highly expressed in labial gland. (6) The clinical features of SS56 positive and negative groups were no significant difference (P> 0.05).Of the laboratory tests, the red blood cells, hemoglobin and erythrocyte sedimentation rate difference was statistically significant (P<0.05).Conclusions:(1)According with 2002 American-European Classification criteria for Sjogren's syndrome, pSS with blood system involvement, liver damage, mucocutaneous involvement coincide between pSS patients in our hospital and pSS of domestic and foreign literature; Lungs involvement, thromboembolic are more than literature, while kidney, thyroid involvement are lower than the literature;(2) Exocrine gland secretory dysfunction of pSS group is more serious than sSS group, especially the salivary gland; (3) SSA, SSB and SS56 in the labial glands of SS patients in both positive expression, and the SSB, SS56 more positive expression than SSA60, these three proteins might be involved in the local inflammatory salivary gland injury and pathogenesis of SS. SS56 expression in the labial glands was consistent with the SSB, anti-SSB antibodies was considered SS mark antibody, suggesting that anti-SS56 antibodies might become one member of the family in SS and other autoimmune diseases, and was expected to become a new diagnostic indicator. (4) The red blood cells and hemoglobin in SS56 positive group were less than the negative group, suggesting that blood system involvement might be heavier in patients with SS56-positive, while ESR elevated significantly in SS56 positive group than negative group, indicating that SS56 might be an indicator of disease activity. (5) SSA highly expressed in serum, while the SSB highly expressed in labial salivary glands, suggesting that expression of two antibodies might have organization specificity.
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