血清IgG4水平在IgG4-PHD鉴别诊断中的价值

目的探讨血清IgG4水平在IgG4相关胰-肝胆疾病(IgG4-PHD)鉴别诊断中的价值。方法回顾性分析2020年1月至2023年7月285例胰肝胆疾病患者的临床资料。根据血清IgG4水平将患者分为IgG4-PHD组(14例)和非IgG4-PHD组(271例)。采用ROC曲线分析血清IgG4水平对IgG4-PHD的最佳诊断阈值、敏感度和特异度。结果血清IgG4≥2.01 g/L时,IgG4-PHD组阳性率明显高于非IgG4-PHD组,差异有统计学意义(P<0.05)。ROC曲线分析显示,以IgG4≥2.255 g/L为诊断阈值鉴别IgG4-PHD与非IgG4-PHD的敏感度为100.00%,特异度为92.30%,AUC为0.979。结论非IgG4-PHD也可以导致血清IgG4水平升高,以2.255 g/L为诊断阈值,可以更好地区分IgG4-PHD和非IgG4-PHD。

Objective To study the application prospect of serum IgG4 level in the differential diagnosis of autoimmune diseases in IgG4-related pancreatic hepatobiliary disease(IgG4-PHD).Methods The clinical data of 285 patients hospitalized in the First Affiliated Hospital of Zhejiang Chinese Medicine University(Zhejiang Hospital of Traditional Chinese Medicine)from January 2020 to July 2023 were retrospectively analyzed.The patients were classified into IgG4-PHD group(14)and other non-hepatobiliary diseases with IgG4-PHD(271).IgG4 in serum was measured by scattering ratio turbidimetry to compare IgG4 levels between different groups.An receiver operating characteristic(ROC)curve analysis was applied to determine the optimal diagnostic threshold,sensitivity,and specificity of serum IgG4 levels to identify IgG4-PHD.Results At serum IgG4≥2.01 g/L,the IgG4-PHD group was significantly higher than the other non-IgG4-PHD group,with a statistically significant difference(P<0.05).In the ROC curve analysis,the sensitivity of IgG4≥2.255 g/L as the diagnostic threshold to differentiate IgG4-PHD from non-IgG4-PHD was 100.00%,specificity of 92.30%and AUC of 0.979.Conclusion Other pancreatic and hepatobiliary diseases with non-IgG4-PHD can also cause increased serum IgG4 levels,with 2.255 g/L as the diagnostic cut-off,which can better distinguish IgG4-PHD from other non-IgG4-PHD diseases.