血清IgG4水平在鉴别诊断IgG4相关肝胆疾病与其他肝胆疾病中的价值

Value of serum IgG4 level for differential diagnosis of IgG4-related hepatobiliary diseases and other hepatobiliary diseases

目的探讨血清IgG4水平在IgG4相关肝胆疾病和其他肝胆疾病鉴别诊断中的应用价值。方法选择2015年8月至2017年4月在湖南省人民医院住院治疗的肝胆疾病患者270例,分为以下8组:肝硬化组(17例)、急性胰腺炎组(52例)、慢性胰腺炎组(33例)、胆囊炎和胆结石组(27例)、胆管癌组(30例)、胆管炎和胆管结石组(41例)、胰腺癌组(47例)、IgG4相关肝胆疾病组(23例)。另外选取20例体检健康者作为对照组。采用速率散射比浊法检测血清中IgG4的水平,应用ROC曲线评价IgG4鉴别诊断IgG4相关肝胆疾病的敏感性和特异性。结果与健康人对照组相比,肝硬化组和IgG4相关肝胆疾病组的IgG4水平明显增高(P均<0.05)。与IgG4相关肝胆疾病组相比,肝硬化组、急性胰腺炎组、慢性胰腺炎组、胆囊炎和胆结石组、胆管癌组、胆管炎和胆管结石组、胰腺癌组的IgG4水平明显降低(Z值分别为-5.267,-6.802,-5.921,-6.005,-6.173,-6.513,-6.014;P值均<0.01)。IgG4在区分IgG4相关肝胆疾病和其他肝胆疾病的AUC为0.982,以4.13 g/L为诊断界值点时,敏感性为95.7%,特异性为96.0%。12例IgG4相关肝胆疾病患者激素治疗后2个月IgG4水平明显低于治疗前(Z=-2.021,P=0.043)。结论血清IgG4升高并不是IgG4相关肝胆疾病所特有。以4.13 g/L为诊断界值点时,IgG4在鉴别诊断IgG4相关性肝胆疾病时具有很高的价值,同时对激素治疗后的疗效判断有一定作用,但需扩大样本进一步验证。

Objective：To investigate the value of serum IgG4 level for the diagnosis of IgG4 related hepatobiliary diseases and the differentiation from other hepatobiliary diseases. Methods：A total of 270 patients with hepatobiliary diseases in the People′s Hospital of Hunan Province from August 2015 to April 2017 were enrolled in this study, and 20 healthy subjects were selected as controls. The 270 patients were divided into eight groups： liver cirrhosis group （n=17）, acute pancreatitis group （n=52）, chronic pancreatitis group （n=33）, cholecystitis and gallstone group （n=27）, bile duct carcinoma group （n=30）, cholangitis and biliary calculi group （n=41）, pancreatic cancer group （n=47）, IgG4-related hepatobiliary disease group （n=23）. The levels of serum IgG4 were measured by rate nephelometery assay. The sensitivity and specificity of IgG4 levels for distinguishing IgG4 associated hepatobiliary diseases were evaluated by receiver operating characteristic curve. Results：The levels of IgG4 of the cirrhosis group and the IgG4 related hepatobiliary disease group were significantly higher than those of the control group （P〈0.05）. The IgG4 level in the hepatobiliary disease group was significantly higher than those of the other seven groups （Z=-5.267,-6.802,-5.921,-6.005,-6.173,-6.513,-6.014,Pall〈0.01）. The area under curve （AUC） for IgG4 level in distinguishing IgG4 associated hepatobiliary diseases and other hepatobiliary diseases was 0.982. When 4.13 g/L was used as the cut off value of diagnosis, the sensitivity and specificity of IgG4 for diagnosis were 95.7% and 96.0% respectively. The IgG4 levels in twelve patients with IgG associated hepatobiliary diseases after 2 months of glucocorticoid therapy were significantly lower than those before glucocorticoid therapy （Z=-2.021, P=0.043）. Conclusion：The elevated serum IgG4 level may not be specific just for IgG4 related hepatobiliary diseases. The cut off value of 4.13 g/L should be very useful for diagnosing IgG4 related hepatobiliary diseases, differentiating from other hepatobiliary diseases and evaluating the therapeutic effect of glucocorticoid therapy. The further detailed verification for these findings should be necessary in clinical practice by increasing the sample size.