CT增强影像学联合血清IgG4和CA199检测在自身免疫性胰腺炎鉴别诊断中的临床价值

Clinical value of CT enhanced imaging combined with serum IgG4 and CA199 detection in differential diagnosis of autoimmune pancreatitis

目的:探究CT增强影像学检查联合血清免疫球蛋白G4(IgG4)与糖类抗原199(CA199)对自身免疫性胰腺炎(AIP)的诊断价值。方法:选取我院2013年11月~2018年3月收治并确诊的53例AIP患者、47例胰腺癌患者与同期来院体检的59位健康人分别作为AIP组、胰腺癌组及健康对照组。对所有受试者进行CT平扫及增强扫描,测定血清IgG4与CA199水平,分析各检查对AIP的诊断价值。结果:健康对照组胰腺CT表现正常;AIP组患者胰腺局灶性密度下降、胰管截断、血管侵犯率明显低于胰腺癌组患者(P<0.05);而胰腺肿胀、肝脏受累、被膜样边缘率明显高于胰腺癌组(P<0.05);AIP组患者胰腺肿块动脉期与门脉期CT值较本组正常胰腺实质明显减小(P<0.05);胰腺癌组患者胰腺肿块动脉期、门脉期与肝脏期CT值较本组正常胰腺实质明显减小(P<0.05);且AIP组胰腺肿块动脉期、门脉期与肝脏期CT值明显大于胰腺癌组(P<0.05);AIP组患者血清IgG4水平明显高于胰腺癌组及健康对照组(P<0.05);AIP组患者血清CA199水平明显低于胰腺癌组患者,但明显高于健康对照组(P<0.05);CT增强影像学诊断AIP的灵敏度及特异度分别为47.17%和79.14%;血清IgG4诊断AIP的灵敏度及特异度分别为77.38%和86.25%;血清CA199诊断AIP的灵敏度及特异度分别为58.49%和81.61%;CT增强影像学联合血清IgG4和CA199诊断AIP的灵敏度及特异度分别为85.47%和89.31%。结论:CT增强影像学联合血清IgG4和CA199检测对AIP诊断有较高的准确性,三者联合检查具有重要的临床价值。

Objective:To investigate value of CT enhanced imaging combined with serum immunoglobulin G4 (IgG4) and carbohydrate antigen 199 (CA199) for autoimmune pancreatitis (AIP).Methods:A total of 53 AIP patients,47 patients with pancreatic cancer and 59 healthy examinees admitted to our hospital from November 2013 to March 2018 were selected as AIP group,pancreatic cancer group and healthy control group.All subjects underwent CT plain scan and enhanced scan,and detection of serum IgG4 and CA199 levels,analyzethe diagnostic value of each examination for AIP.Results:The CT findings of the pancreas in the healthy control group were normal;the focal pancreatic density,pancreatic duct truncation and vascular invasion rates in AIP group were significantly lower than those in pancreatic cancer group (P<0.05),while the rates of pancreatic swelling,liver involvement and capsular margin were significantly higher than those in pancreatic cancer group (P<0.05).CT values of pancreatic masses at arterial and portal phases ranking in an ascending order among three groups were AIP group,pancreatic cancer group and healthy control group (P<0.05).The serum IgG4 level in AIP group was significantly higher than that in pancreatic cancer group and healthy control group (P<0.05).The level of serum CA199 in AIP group was significantly lower than that in pancreatic cancer group,but significantly higher than that in healthy control group (P<0.05).The sensitivity and specificity of CT enhanced imaging,serum IgG4,CA199,as well as the combined detection of the three in the diagnosis of AIP were 47.17% & 79.14%,77.38% & 86.25%,58.49% & 81.61% and 85.47% & 89.31%.Conclusion:CT enhanced imaging combined with serum IgG4 and CA199 detection has a high accuracy in the diagnosis of AIP,which has important clinical value.