自身免疫性胰腺炎患者血清IgG4变化及其临床意义研究

Study of serum IgG4 levels in patients with autoimmune pancreatitis and its clinical significance

目的:探讨自身免疫性胰腺炎(AIP)患者血清IgG4的动态变化及其临床意义。方法:选取福建医科大学附属第二医院2015年1月~2018年1月收治的31例AIP患者,采用速率散射比浊法动态检测AIP患者血清中IgG4水平,分析其与临床特征、受累器官CT影像学形态变化、1年复发率、2年复发率、3年复发率和3年生存率的相关性。结果:弥漫型AIP患者血清IgG4水平较局灶型/节段型明显增高(P<0.05),有症状者较无症状者明显增高(P<0.01),有胰腺外器官组织受累较单纯胰腺受累明显增高,并且胰腺外受累器官种数越多,血清IgG4水平越高(P<0.01)。治疗有效组血清IgG4水平治疗后较治疗前明显降低(P<0.01),治疗无效组血清IgG4水平治疗前后变化不显著(P>0.05)。血清IgG4水平与胰腺CT影像学形态变化趋势(P=0.508)和胰腺外受累器官CT影像学形态变化趋势(P=0.727)一致性较好,胰腺与胰腺外受累器官CT影像学形态变化趋势一致性差(P=0.039)。AIP患者治疗前血清IgG4水平、治疗前后IgG4水平下降幅度与1年复发率、2年复发率、3年复发率和3年生存率相关(P均<0.05),但治疗结束时血清IgG4水平与复发和预后无显著相关(P均>0.05)。结论:AIP患者血清IgG4水平与病情、疗效、复发、预后密切相关,动态检测IgG4水平对估计病情、治疗监测、预测复发和判断预后有重要意义。

Objective:To investigate the dynamic change and clinical significance of serum IgG4 in patients with autoimmune pancreatitis(AIP).Methods:31 AIP patients diagnosed in the Second Affiliated Hospital of Fujian Medical University from Jan.2015 to Jan.2018 were selected.The rate scattering turbidimetry were used to dynamically measure serum IgG4 level of AIP patients.The correlation between serum IgG4 level and the clinical features,organs infiltration,morphological changes of CT imaging,1-year recurrence rate,2-year recurrence rate,3-year recurrence rate and 3-year survival rate in AIP patients were analyzed.Results:We found that the level of serum IgG4 in patients with diffuse AIP was significantly higher than that in patients with focal or segmental type(P<0.05)and in patients with symptoms was significantly higher than that in patients without symptoms(P<0.01).Besides,we found that the level of serum IgG4 in the group with extrapancreatic organs involvement was also higher than the group with simple pancreatic involvement(P<0.01).The more species of extrapancreatic involved organs,the higher the level of serum IgG4(P<0.05).In terms of treatment,the level of serum IgG4 in the effective group was significantly lower than that before treatment(P<0.01)and no significant change was observed in the ineffective group before and after treatment.In addition,the level of serum IgG4 was in good agreement with the morphological changes of CT imaging of pancreas(P=0.508)and extrapancreatic involved organs(P=0.727).But the consistency of morphological changes of CT imaging between pancreas and extrapancreatic involved organs was poor(P=0.039).The level of serum IgG4 before treatment and the decrease of IgG4 level before and after treatment were correlated with 1-year recurrence rate,2-year recurrence rate,3-year recurrence rate and 3-year survival rate(P<0.05).However,there was no correlation between serum IgG4 level and recurrence and prognosis at the end of treatment(P>0.05).Conclusion:The level of serum IgG4 in patients with AIP is closely related to the disease condition,curative effect,recurrence and prognosis.Dynamic detection of serum IgG4 level is of great significance for estimating the disease condition,monitoring treatment,predicting recurrence and guiding prognosis.