BERKHOF, BAS (2021) SIALOMETRY AND SIALOCHEMISTRY AS A SCREENING TOOL FOR PRIMARY SJÖGREN’S SYNDROME. thesis, Dentistry.
Full text available on request.Abstract
INTRODUCTION In patients with Sjögren’s Syndrome (SS) the salivary secretion is reduced and the composition of saliva can be changed. An increased concentration of Na+ is reported most frequently. It is unclear if the composition of saliva of patients who are suspected of SS can be used for screening of patients with sicca complaints for SS. It is also unknown if the salivary gland histomorphology of patients with SS relates to compositional changes observed in saliva of SS patients. This leads to the objective of this study: to establish whether the sialochemical composition discriminates between SS patients and non-SS patients, and whether it is associated with glandular histopathological features of SS. To this end the following research questions were defined: 1. Does the sialometric profile and salivary composition of parotid saliva and submandibular/sublingual saliva differ between sicca patients that fulfil the classification criteria for SS and patients not fulfilling these criteria (non-SS sicca)? 2. Is the sialochemical composition of parotid saliva associated with the histopathology of biopsies of the parotid glands of SS patients? METHOD This study concerned a retrospective cohort study based on 129 patients with sicca complaints. Mann-Whitney U tests were used to compare sialometric and sialochemical parameters in saliva between groups of patients classified as SS patients or as non-SS sicca patients. With univariate and multivariate linear regressions, it was analyzed whether the sialochemical composition of parotid saliva was associated with the histopathological features of the biopsies of the parotid gland of SS patients. RESULTS This study has shown that there is a lower salivary flowrate of unstimulated whole saliva (UWS), stimulated whole saliva, stimulated by paraffin (SWS (paraffin)), SWS, stimulated by citric acid (SWS citric acid) and (un)stimulated submandibular/sublingual saliva (SM/SL saliva) in the SS group compared to the non-SS sicca group (p<0.05). Additionally, Na+ concentration is significantly higher in the SS group compared to the non-SS sicca group in all saliva samples (p < 0.001 (parotid saliva, unstimulated SM/SL saliva), p < 0.01 (stimulated SM/SL saliva)). Furthermore, this study has shown that the concentration of Na+ in parotid specific saliva was significantly associated with a rise in the focus score (p < 0.001), the percentage of CD45 infiltrate (p < 0.001) and the maximum severity of the lymfoepithelial lesions (LELs) (p < 0.05) of the parotid biopsy. DISCUSSION AND CONCLUSION It is hypothesized that a lymphocytic infiltrate in the gland causes less resorption of Na+ in the ducts. It is speculated that the lymphocytic infiltrate produces inflammatory cytokines which might affect the functioning of Na+ channels that resorb Na+ from the saliva in the ducts and with that cause a higher concentration of Na+ in saliva. This knowledge might lead to using Na+ concentration in saliva as a pseudomarker for the amount of infiltrate and therefore as a less invasive screening test for SS in patients suspect for SS.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | KROESE, F.G.M. and VISSINK, A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 24 Apr 2023 11:41 |
| Last Modified: | 24 Apr 2023 11:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3487 |
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