血清IgG_(4)水平检测在IgG_(4)相关肝胆胰疾病诊断及疗效评估的价值研究

Value of Serum IgG_(4)Level in the Diagnosis and Therapeutic Effect Evaluation of IgG_(4)-related Hepatobiliary and Pancreatic Diseases

目的研究血清免疫球蛋白(Ig)G4水平在IgG_(4)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IgG_(4)水平检测且明确诊断为肝胆胰疾病的患者267例,将其分为IgG_(4)相关肝胆胰疾病组(n=19)和非IgG_(4)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IgG_(4),比较各组血清IgG_(4)水平。应用ROC曲线评价血清IgG_(4)水平鉴别诊断IgG_(4)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IgG_(4)水平之间的相关性。结果IgG_(4)相关肝胆胰疾病组血清IgG_(4)水平[3.86(2.25,6.90)g/L]显著高于非IgG_(4)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IgG_(4)相关肝胆胰疾病中胆管肿瘤疾病组有20%(4/20)的患者IgG_(4)水平高于正常值,在非IgG_(4)相关肝胆胰疾病中阳性率最高。通过IgG_(4)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IgG_(4)水平仅与IgG呈显著正相关(r=0.943,P<0.05)。IgG_(4)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%)。IgG_(4)相关肝胆胰疾病患者有效治疗后血清IgG_(4)水平均明显降低(Z=-2.547,P=0.011)。结论血清IgG_(4)水平鉴别诊断IgG_(4)相关肝胆胰疾病最佳诊断界值为2.02g/L。动态观察血清IgG_(4)水平对诊断IgG_(4)相关肝胆胰疾病有重大提示作用。血清IgG_(4)也是判断临床治疗有效的重要指标。

Objective To study the value of serum immunoglobulin(Ig)G4 level in the diagnosis and therapeutic effect evaluation of IgG_(4)-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 IgG_(4)level detection and were diagnosed with hepatobiliary and pancreatic diseases were collected and divided into IgG_(4)-related hepatobiliary and pancreatic disease groups(n=19)and non-IgG_(4)-related hepatobiliary and pancreatic disease group(n=248).In addition,50 healthy subjects were selected as the control group.Serum IgG_(4)was detected by latex immunoturbidimetry,and the levels of serum IgG_(4)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 IgG_(4)levels for differential diagnosis of IgG_(4)-related hepatobiliary and pancreatic diseases.Collected test data of laboratory and analyzed the correlation between other laboratory indicators and serum IgG_(4)levels.Results The serum IgG_(4)level in the IgG_(4)-related hepatobiliary and pancreatic disease group[3.86(2.25,6.90)g/L]was significantly higher than that in the non-IgG_(4)-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-IgG_(4)-related hepatobiliary and pancreatic diseases,20%(4/20)of the patients in the bile duct tumor disease group had IgG_(4)levels higher than the normal value,and the positive rate was the highest in the non-IgG_(4)-related hepatobiliary and pancreatic diseases.The ROC curve was drawn by the IgG_(4)-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 IgG_(4)levels were only significantly correlated with IgG(r=0.943,P<0.05).The top three positive rates of other laboratory indicators in the IgG_(4)-related hepatobiliary and pancreatic disease group were GGT(75%),ALP(68.75%)and fasting GLU(61.11%).Serum IgG_(4)levels were significantly decreased in patients with IgG_(4)-related hepatobiliary and pancreatic diseases after effective treatment(Z=-2.547,P=0.011).Conclusion The optimal diagnostic cut-off value of IgG_(4)-related hepatobiliary and pancreatic diseases for differential diagnosis of IgG_(4)-related hepatobiliary and pancreatic diseases was 2.02g/L.Dynamic observation of serum IgG_(4)levels has a significant hinting effect on the diagnosis of IgG_(4)-related hepatobiliary and pancreatic diseases.Serum IgG_(4)was also an important indicator to judge the effectiveness of clinical treatment.