背景：

        已有报道显示在一些风湿性疾病中男性较女性有更严重的表现。然而，并没有研究建立原发性干燥综合症病人和性别相关的临床特点。因此，在这项研究中，我们调查原发性干燥综合症在男性和女性诊断时的临床表现。

方法：

        特定区域的199个未经治疗的患者被纳入一项5年的前瞻性研究，期间对他们进行原发性干燥综合症诊断标准相关的检查，以及对他们腺体外表现进行检查。在诊断时取血清做样本并用ELISA的方法检测Ro52/SSA抗体。研究的重要结果在一项377例原发性干燥综合症的患者独立队列研究中被重复证实，并做了meta分析。

结果：

        我们发现并证实男性中腺体外累及包括肺部病变、血管炎及淋巴结病变的几率更高，并且在研究队列中发现男性诊断年龄更小。此外，SSA抗体阳性的男性患者比女性的Ro-52检测水平更高。

结论：

        我们对两组独立队列研究证实，在诊断原发性干燥综合症时，男性患者的腺体外累及明显多于女性患者。约一半的男性患者在诊断原发性干燥综合症时存在腺体外累及，说明干燥综合症在男性患者中有更严重的表现形式，尽管男性发病率较低。

附原文：

Background：

        A more severe disease phenotype has been reported in men compared to women in several rheumatic diseases. However, studies have not conclusively established sex-related clinical features in primary Sjögren’s syndrome (pSS). In this study, we therefore investigated the clinical presentation of pSS in women and men at diagnosis.

Methods:

        Incident, treatment naïve patients (n = 199) during a 5-year period in a specified area were prospectively included and examined for items of classification criteria for pSS as well as extraglandular manifestations (EGM). Serum was sampled at the time of diagnosis and anti-Ro52/SSA levels were measured by ELISA. Replication of significant findings was confirmed in an independent cohort of pSS patients (n = 377), and meta-analysis was performed.

Results:

        An increased frequency of extraglandular manifestations in men was observed and replicated (p = 0.05, p = 0.0003, and p meta = 0.002). This related to pulmonary involvement, vasculitis, and lymphadenopathy being more common in men, for whom a lower age at diagnosis was observed in the exploratory cohort. Additionally, SSA-positive male patients had significantly higher levels of anti-Ro52 levels than their female counterparts in sera available for analysis (p = 0.02).

Conclusions:

        Our analysis of two independent cohorts of incident pSS demonstrates that the presence and number of EGM are significantly more frequent among men with pSS than women at diagnosis. Importantly, around half of the male patients presented with more than one EGM at diagnosis, supporting the conclusion that pSS in men represents a more severe form of disease, regardless of the lower risk for men to develop pSS.

引自：

        Ramírez Sepúlveda JI, Kvarnström M, Brauner S, Baldini C, Wahren-Herlenius M.Difference in clinical presentation between women and men in incident primary Sjögren's syndrome.BIOLOGY OF SEX DIFFERENCES，2017.5(12)