[1]罗 盈,王子霞,李 彤,等.血清IgG4 水平检测在IgG4 相关肝胆胰疾病诊断及疗效评估的价值研究[J].现代检验医学杂志,2022,37(06):70-75.[doi:10.3969/j.issn.1671-7414.2022.06.013]
　LUO Ying,WANG Zi-xia,LI Tong,et al.Value of Serum IgG4 Level in the Diagnosis and Therapeutic Effect Evaluation of IgG4-related Hepatobiliary and Pancreatic Diseases[J].Journal of Modern Laboratory Medicine,2022,37(06):70-75.[doi:10.3969/j.issn.1671-7414.2022.06.013]
点击复制

血清IgG4 水平检测在IgG4 相关肝胆胰疾病诊断及疗效评估的价值研究()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第37卷
期数:
2022年06期
页码:
70-75
栏目:
论著
出版日期:
2022-11-15

文章信息/Info

Title:
Value of Serum IgG4 Level in the Diagnosis and Therapeutic Effect Evaluation of IgG4-related Hepatobiliary and Pancreatic Diseases
文章编号:
1671-7414(2022)06-070-06
作者:
罗 盈1; 王子霞1; 李 彤2; 陈敏静1; 姚亚男1; 周 晖1
(1. 广东省人民医院/ 广东省医学科学院检验科, 广州 510080；2. 广州南方学院，广州 510080)
Author(s):
LUO Ying1;  WANG Zi-xia1;  LI Tong2;  CHEN Min-jing1;  YAO Ya-nan1;  ZHOU Hui1
(1.Depatment of Clinical Laboratory,Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences, Guangzhou 510080, China; 2. Southern College Guangzhou, Guangzhou 510080, China)
关键词:
血清IgG4; IgG4 相关肝胆胰疾病; 肝胆胰疾病
分类号:
R575；R576；R446.61
DOI:
10.3969/j.issn.1671-7414.2022.06.013
文献标志码:
A
摘要:
目的 研究血清免疫球蛋白(Ig)G4 水平在IgG4 相关肝胆胰疾病的诊断及疗效评估中的价值。方法 通过收集2020 年 8 月～ 2022 年 3 月来广东省人民医院检验科进行血清 IgG4 水平检测且明确诊断为肝胆胰疾病的患者267 例，将其分为IgG4 相关肝胆胰疾病组(n=19)和非IgG4 相关肝胆胰疾病组(n=248)。另外选取 50 例体检健康者作为对照组。采用乳胶免疫比浊法检测血清IgG4，比较各组血清IgG4 水平。应用ROC 曲线评价血清IgG4 水平鉴别诊断IgG4 相关肝胆胰疾病的最佳诊断界值及敏感度和特异度。收集实验室检测资料，分析其他实验室指标与血清IgG4 水平之间的相关性。结果 IgG4 相关肝胆胰疾病组血清IgG4 水平[3.86(2.25，6.90)g/L] 显著高于非IgG4 相关肝胆胰疾病组[0.75(0.47，1.29)g/L] 和健康对照组[0.71(0.40，1.03)g/L]，差异具有统计学意义(Z = 3.641,6.314, 均P ＜ 0.01)。非IgG4 相关肝胆胰疾病中胆管肿瘤疾病组有20%(4/20) 的患者IgG4 水平高于正常值，在非IgG4 相关肝胆胰疾病中阳性率最高。通过IgG4 相关肝胆胰疾病组和其他对照组绘制ROC 曲线，最佳诊断界值为2.02g/L，AUC 为0.875(95%CI：0.953 ～ 0.995)。血清IgG4 水平仅与IgG 呈显著正相关(r=0.943，P ＜ 0.05)。IgG4 相关肝胆胰疾病组中其他实验室指标阳性率排名前三的是GGT(75.00%)，ALP(68.75%)和空腹GLU(61.11%)。IgG4 相关肝胆胰疾病患者有效治疗后血清IgG4 水平均明显降低(Z=-2.547，P=0.011)。结论 血清IgG4 水平鉴别诊断 IgG4 相关肝胆胰疾病最佳诊断界值为2.02g/L。动态观察血清IgG4 水平对诊断IgG4 相关肝胆胰疾病有重大提示作用。血清IgG4 也是判断临床治疗有效的重要指标。
Abstract:
Objective To study the value of serum immunoglobulin (Ig) G4 level in the diagnosis and therapeutic effect evaluation of IgG4-related hepatobiliary and pancreatic diseases. Methods From August 2020 to March 2022, 267 patients who came to the Department of Clinical Laboratory, Guangdong Provincial People’s Hospital for serum IgG4 level detection and were diagnosed with hepatobiliary and pancreatic diseases were collected and divided into IgG4-related hepatobiliary and pancreatic disease groups (n=19) and non-IgG4-related hepatobiliary and pancreatic disease group (n=248). In addition, 50 healthy subjects were selected as the control group. Serum IgG4 was detected by latex immunoturbidimetry, and the levels of serum IgG4 in each group were analyzed and compared. The ROC curve was used to evaluate the optimal diagnostic cut-off value, sensitivity and specificity of serum IgG4 levels for differential diagnosis of IgG4-related hepatobiliary and pancreatic diseases. Collected test data of laboratory and analyzed the correlation between other laboratory indicators and serum IgG4 levels. Results The serum IgG4 level in the IgG4-related hepatobiliary and pancreatic disease group [3.86 (2.25, 6.90) g/L] was significantly higher than that in the non-IgG4-related hepatobiliary and pancreatic disease group [0.75 (0.47, 1.29) g/L] and the healthy control group [0.71 (0.40, 1.03)g/L], and the differences were statistically significant (Z=3.641, 6.314, all P<0.01). Among the non-IgG4-related hepatobiliary and pancreatic diseases, 20% (4/20) of the patients in the bile duct tumor disease group had IgG4 levels higher than the normal value, and the positive rate was the highest in the non-IgG4-related hepatobiliary and pancreatic diseases. The ROC curve was drawn by the IgG4-related hepatobiliary and pancreatic disease group and other control groups, the optimal diagnostic cutoff was 2.02 g/L, and the AUC was 0.875 (95%CI: 0.953~0.995). Serum IgG4 levels were only significantly correlated with IgG (r=0.943, P ＜ 0.05). The top three positive rates of other laboratory indicators in the IgG4-related hepatobiliary and pancreatic disease group were GGT (75%), ALP (68.75%) and fasting GLU (61.11%). Serum IgG4 levels were significantly decreased in patients with IgG4-related hepatobiliary and pancreatic diseases after effective treatment (Z=-2.547, P=0.011). Conclusion The optimal diagnostic cut-off value of IgG4-related hepatobiliary and pancreatic diseases for differential diagnosis of IgG4-related hepatobiliary and pancreatic diseases was 2.02g/L. Dynamic observation of serum IgG4 levels has a significant hinting effect on the diagnosis of IgG4-related hepatobiliary and pancreatic diseases. Serum IgG4 was also an important indicator to judge the effectiveness of clinical treatment.

参考文献/References:

[1] 张文 ,董凌莉 ,朱剑等 .IgG4相关性疾病诊治中国专家共识 [J].中华内科杂志 ,2021,60(3):192-206. ZHANG Wen, DONG Lingli, ZHU Jian, et al. Chinese expert consensus on the diagnosis and treatment of IgG4 related diseases [J]. Chinese Journal of Internal Medicine,2021,60(3):192-206.
[2] 林丽萍 , 阮一平 , 洪富源． IgG4相关疾病最新研究进展 [J].疑难病杂志 , 2020, 19(7): 750-754． LIN Liping, RUAN Yiping, HONG Fuyuan. Recent advances in IgG4-related disease [J]. Chinese Journal of Di?cult and Complicated Cases, 2020, 19(7): 750-754.
[3] 连敏 , 马雄 .免疫球蛋白 G4相关肝胆胰疾病研究进展与展望 [J].中国医学前沿杂志 (电子版 ), 2020, 12(2): 3-6. LIAN Min, MA Xiong. Progress and prospects of immunoglobulin G4-related hepatobiliary-pancreatic disease [J]. Chinese Journal of the Frontiers of Medical Science(Electronic Version),2020,12(02):3-6.
[4] 王金泉． IgG4相关疾病的早期诊断及鉴别诊断 [J].解放军医学杂志 , 2020, 45(7): 772-780． WANG Jinquan. The early diagnosis and differential diagnosis of IgG4-related diseases [J]. Medical Journal of Chinese People’s Liberation Army,2020,45(7):772-780.
[5] JIAN Jiao, ZHANG Shanshan, ZHANG Jun, et al. Advocating early identification and diagnosis of IgG4-related disease in various clinical specialties[J]. European Journal of Internal Medicine, 2022, 99: 124-125.
[6] UMEHARA H, OKAZAKI K, MASAKI Y, et al. Comprehensive diagnostic criteria for IgG4-related disease(IgG4-RD),2011[J]. Modern Rheumatology, 2012, 22(1): 21-30.
[7] 中华医学会外科学分会胰腺外科学组 .胰腺癌诊治指南 (2014)[J].中国实用外科杂志 , 2014, 34(11)： 1011-1017. Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association. Guidelines for the diagnosis and treatment of pancreatic cancer [J]. Chinese Journal of Practical Surgery,2014,34 (11) : 1011-1017.
[8] 王成锋 .胰腺囊性肿瘤的诊治策略 [J].中华医学杂志 , 2014, 94(2):81-82. WANG Chengfeng. Diagnosis and treatment of pancreatic cystic tumors[J]. National Medical Journal of China,2014,94(2):81-82.
[9] 王春友 , 李非 , 赵玉沛 .急性胰腺炎诊治指南 (2014) [J].中华普通外科学文献 (电子版 ), 2015, 9(2): 86-89. WANG Chunyou, LI Fei, ZHAO Yupei, et al. Diagnosis and treatment guidelines for acute pancreatitis (2014) [J]. Chinese Archives of General Surgery(Electronic Edition) ,2015,9(2):86-89.
[10] 中国医师协会胰腺病专业委员会慢性胰腺炎专委会 .慢性胰腺炎诊治指南 (2018年 ,广州 )[J].中华消化杂志 , 2018, 38(1): 739-746. Chronic Pancreatitis Group of Pancreatic Disease Committee of Chinese Medical Doctor Association. Guideline for the diagnosis and treatment of chronic pancreatitis (2018, Guangzhou) [J]. Chinese Journal of Digestion, 2018, 38 (11) : 739-746.
[11] 梁后杰 , 秦叔逵 , 沈锋 , 等 .CSCO胆道系统肿瘤诊断治疗专家共识 (2019年版 )[J].临床肿瘤学杂志 , 2019, 24(9): 828-838. LIANG Houjie, QIN Shukui, SHEN Feng,et al. Expert consensus on diagnosis and treatment of CSCO biliary systerm tumors(2019 edition)[J]. Chinese Clinical Oncology, 2019, 24 (9): 828-838.
[12] 中华医学会外科学分会胆道外科学组 .肝胆管结石病诊断治疗指南 [J].中华消化外科杂志 , 2007, 6(2): 156-160, 封 3. Branch of Biliary Surgery, Chinese Society of Surgery, Chinese Medical Association. Guidelines for diagnosis and treatment of hepatolithiasis[J]. Chinese Journal of Digestive Surgery,2007, 6 (2) : 156-160, F3.
[13] 中华消化杂志编辑委员会 , 中华医学会消化病学分会肝胆疾病协作组 .中国慢性胆囊炎、胆囊结石内科诊疗共识意见 (2018年 )[J].中华消化杂志 , 2019, 39(2): 73-79. Editorial Board of Chinese Journal of Digestion, Cooperation Group of Hepatobiliary Diseases of Chinese Society of Gastroenterology. Consensus on diagnosis and treatment of chronic cholecystitis and gallstones in China (2018) [J]. Chinese Journal of Digestion, 2019, 39 (2) 73-79.
[14] 刘文斌 , 荚卫东．《原发性肝癌诊疗规范 (2019年版 )》解读 [J].肝胆外科杂志 , 2020, 28(6): 468-472. LIU Wenbin, JIA Weidong. Interpretation of Guidelines for diagnosis and treatment of primary liver cancer in China (2019 edition) [J]. Journal of Hepatobiliary Surgery, 2020, 28(6): 468-472.
[15] 中华医学会肝病学分会 .肝硬化诊治指南 [J].中华肝脏病杂志 , 2019, 27(11): 846-865. Chinese Society of Hepatology,Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis [J]. Chinese Journal of Hepatology, 2019, 27 (11) : 846-865.
[16] WALLACE Z S, NADEN R P, CHARI S, et al. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-Related disease[J]. Ann Rheum Dis, 2020, 79(1):77-87.
[17] 刘航 , 杨娉婷 , 肖卫国 , 等．解读“ 2019年 ACR及 EULAR IgG4相关性疾病分类标准” [J].中华临床免疫和变态反应杂志 , 2019, 13(6): 447-453. LIU Hang, YANG Pingting, XIAO Weiguo, et al. Interpreting of “The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease”[J]. Chinese Journal of Allergy and Clinical Immunology,2019,13(6):447-453.
[18] 王天琪 , 刘燕鹰．IgG4相关肝胆胰疾病诊疗进展 [J].临床肝胆病杂志 , 2022, 38(4)：762-766． WANG Tianqi, LIU Yanying. Advances in diagnosis and treatment of IgG4-related hepatobiliary and pancreatic diseases[J]. Journal of Clinical Hepatology,2022,38(4):762-766.
[19] LIAN Min, LI Bo, XIAO Xiao, et al. Comparative clinical characteristics and natural history of three variants of sclerosing cholangitis: IgG4-related SC, PSC/AIH and PSC alone[J]. Autoimmunity Reviews, 2017, 16(8): 875-882.
[20] 夏长胜 , 樊春红 , 王辉．血清 IgG4和 IgG4/IgG比值诊断Ⅰ型自身免疫性胰腺炎的最佳临界值及性能评价 [J].检验医学 , 2019, 34(4): 322-326. XIA Changsheng, FAN Chunhong, WANG Hui. Evaluation of optimal cut-off value and performance of serum IgG4 and IgG4/IgG ratio in the diagnosis of type Ⅰ autoimmune pancreatitis[J]. Laboratory Medicine ,2019,34(4):322-326.
[21] 李畅 , 闫雷 , 王丽 , 等 .血清 IgG4水平对 IgG4相关胰 -肝胆疾病与非 IgG4相关胰-肝胆疾病的鉴别诊断价值 [J].临床肝胆病杂志 , 2022, 38(6): 1307-1310. LI Chang, YAN Lei, WANG Li, et al. Value of serum IgG4 level in differential diagnosis of IgG4-related pancreatic and hepatobiliary diseases and non-IgG4-related pancreatic and hepatobiliary diseases [J]. Journal of Clinical Hepatology,2022,38(6): 1307-1310.
[22] NAKAZAWA T, NAITOH I, HAYASHI K, et al. Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification[J]. Journal of Gastroenterology, 2012, 47(1): 79-87.
[23] OSEINI A M, CHAITEERAKIJ R, SHIRE A M, et al. Utility of serum immunoglobulin G4 in distinguishing immunoglobulin G4-associated cholangitis from cholangiocarcinoma[J]. Hepatology, 2011, 54(3): 940-948.
[24] 李洁琼 , 张文 .糖皮质激素在 IgG4相关性疾病中的应用[J].中华临床免疫和变态反应杂志, 2019, 13 (6): 464-467． LI Jieqiong, ZHANG Wen. Glucocorticoids therapy in IgG4-related disease [J]. Chinese Journal of Allergy & Clinical Immunology,2019,13(6):464-467.
[25] ZHANG Yajing, ZHENG Jianxing, WANG Libing, et al. The value of serum IgG4 level in the differential diagnosis of IgG4-related hepatobiliary diseases and other hepatobiliary diseases[J]. Acta Medica Mediterranea, 2019, 35(2): 883-885.
[26] 蒋筠斐 , 须静 , 钟政荣 .支气管哮喘患者外周血 TIM4, IgG4及 EOS水平表达与其肺功能 ,哮喘发病严重程度及预后的相关性研究 [J].现代检验医学杂志 , 2021, 36(5): 148-152. JIANG Yunfei, XU Jing, ZHONG Zhengrong . Correlation of peripheral blood TIM4, IgG4 and EOS expression levels with the prognosis in bronchial asthma patients [J]. Journal of Modern Laboratory Medicine,2021,36(5):148-152.
[27] CULVER E L, SADLER R, BATEMAN A C, et al. Increases in IgE, eosinophils, and mast cells can be used in diagnosis and to predict relapse of IgG4-Related disease[J]. Clinical Gastroenterology and Hepatology, 2017, 15(9): 1444-1452, e6.

备注/Memo

备注/Memo:
基金项目：2021 年广州市科技基础与应用基础研究项目(202102020767)。
作者简介：罗盈(1985-)，女，本科，主管技师，主要从事自身免疫性疾病工作及研究，E-mail: jianfanhappy@126.com。
通讯作者：王子霞，女，博士，E-mail: wangzixia@gdph.org.cn。
更新日期/Last Update: 2022-11-15