Significance of tongue tissue biopsy in the diagnosis of systemic amyloidosis
Objective:Amyloidosis is a rare heterogeneous disease.The median survival time varies significantly due to the involvement of different organs.The diagnosis relies heavily on pathology,but due to the difficulty of biopsy in important organs,the positive rate of diagnosis by skin biopsy and bone marrow biopsy is low.Therefore,a readily implementable and less invasive diagnostic method is needed,which is of great significance for clarifying the diagnosis.Methods:A retrospective analysis was conducted on the clinical data of 36 patients suspected of having systemic amyloidosis affecting other organs who underwent tongue biopsy at Beijing Chaoyang Hospital affiliated to Capital Medical University from 2017 to 2023.Demographic information,laboratory test results,other auxiliary examination results,and pathological results of the patients were collected.The differences in gender,age,disease duration,number of chemotherapy sessions,and tongue clinical examination among patients suspected of having systemic amyloidosis were statistically analyzed.The total positive rate of tongue biopsy was calculated,and the correlation between myocardial enzyme abnormalities,renal function abnormalities,blood light chain protein abnormalities,positive echocardiography results,positive cardiac magnetic resonance imaging results,tongue texture(tough),tongue movement(restricted),presence of tooth marks around the tongue,creatine kinase(blood),brain natriuretic peptide(BNP)(blood)levels,electrolyte abnormalities,β2-microglobulin(blood),and the proportion of plasma cells in bone marrow cytology with tongue biopsy results was tested using Spearman correlation analysis.The positive rate of fat biopsy was calculated and compared with tongue biopsy results and echocardiographic results.Logistic stepwise regression was used to analyze the related factors of tongue biopsy results.Results:Among the 36 patients,there were 19 cases of multiple myeloma(MM),9 cases of primary light chain amyloidosis(pAL),and 8 cases of monoclonal gammopathies of clinical significance(MGCS).There were no statistically significant differences in gender composition,age,disease duration,and number of chemotherapy sessions among the three diseases(all P>0.05).There were statistically significant differences in tongue texture(tough)and tongue movement(restricted)among the three diseases(P<0.05),while the presence of tooth marks around the tongue showed no significant difference(P>0.05).The total positive rate of tongue biopsy was 52.78%.Spearman correlation analysis revealed a significant positive correlation between myocardial enzyme abnormalities(r=0.35,P<0.05),positive echocardiography results(r=0.51,P<0.05),tongue texture(tough)(r=0.44,P<0.05),tongue movement(restricted)(r=0.42,P<0.05),BNP(blood)levels(r=0.43,P<0.05),and positive tongue biopsy results;while the presence of tooth marks around the tongue showed a significant negative correlation with positive tongue biopsy results(r=-0.33,P<0.05).Fat biopsy results showed that the positive rate of fat biopsy was only 25.00%,while the positive rate of tongue biopsy was 50.0%.Logistic stepwise regression analysis suggested that myocardial enzyme abnormalities and tongue texture(tough)were related factors for positive tongue biopsy results[odds ratio(OR)values were 9.520 and 10.000,both P<0.05].Conclusion:For patients suspected of amyloidosis involving the myocardium,tongue biopsy is the optimal choice if there are abnormal tongue movements or changes in texture,which can assist in early and accurate diagnosis.
万方数据
维普
