Can serum immunoglobulin G4 levels and age serve as reliable predictors of relapse in autoimmune pancreatitis?

We are writing in response to the paper published in the World Journal of Gastroenterology by Zhou et al.The authors identified higher serum immunoglobulin(Ig)G4 levels and age over 55 years as independent risk factors for disease relapse.Despite notable strengths,it is crucial to address potential biases.Firstly,the cohort study included 189 patients with autoimmune pancreatitis(AIP)type 1(with higher IgG4 seropositivity and higher relapse)and 24 with type 2(with lower IgG4 seropositivity and lower relapse).Consequently,most,if not all,AIP type 2 patients were assigned to the normal group,possibly inflating the association of higher serum IgG4 levels with relapse and potentially exaggerating the association of older age with relapse.Secondly,the authors did not provide sufficient details regarding AIP diagnosis,such as the ratio of definitive vs probable cases and the proportion of biopsies.In cases where histological evidence is unavailable or indeterminate,AIP type 2 may be misdiagnosed as definitive type 1,and type 1 may also be misdiagnosed as probable type 2,particularly in cases with normal or mildly elevated serum IgG4 levels.Lastly,in this retrospective study,approximately one-third of the consecutive patients initially collected were excluded for various reasons.Accordingly,the impact of nonrandom exclusion on relapse outcomes should be carefully considered.In conclusion,the paper by Zhou et al offers plausible,though not entirely compelling,evidence suggesting a predictive role of elevated serum IgG4 levels and advanced age in AIP relapse.The foundation for future investigations lies in ensuring a reliable diagnosis and accurate disease subtyping,heavily dependent on obtaining histological specimens.In this regard,endoscopic ultrasound-guided fine-needle biopsy emerges as a pivotal component of the diagnostic process,contributing to mitigating biases in future explorations of the disease.

Serum Immunoglobulin Concentrations in Juvenile Idiopathic Arthritis Cases during Active and Inactive Disease States

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Both the humoral and cell mediated immunities are involved in the pathogenesis of JIA. It is reported that overall immunoglobulin levels in JIA patients are significantly higher than their control during the active state of disease. Methodology: This prospective observational study was conducted over a period of 18 months All the newly diagnosed oligo-articular and poly-articular JIA patients having active disease were included by purposive sampling. Data were collected by a semi-structured predesigned questionnaire. Result: Most of the study subjects (57.6%) belonged to age group > 3 - 9 years. Oligo JIA was diagnosed in 66.7% and poly JIA in 33.3% of JIA children. The difference in mean (±SD) ESR (33.52 ± 21.29 and 15.09 ± 7.71 mm in 1st hour) at active and inactive states was highly significant. Mean (±SD) difference of IgG, IgM and IgA in active and inactive states of disease were highly significant. Conclusion: Higher and abnormal levels of immunoglobulin (IgG, IgM, and IgA) were present among JIA patients in active disease state which became normal during inactive disease state after treatment.

STAT3-Dependent Effects of Polymeric Immunoglobulin Receptor in Regulating Interleukin-17 Signaling and Preventing Autoimmune Hepatitis

One-third of patients with autoimmune hepatitis(AIH)have cirrhosis at the time of diagnosis.The relevance of these variables,although unknown,is believed to be critical in AIH because of suspected interactions between the gut microbiome and genetic factors.Dysbiosis of the gut flora and elevated polymeric immunoglobulin receptor(pIgR)levels have been observed in both patients and mouse models.Moreover,there is a direct relationship between pIgR expression and transaminase levels in patients with AIH.In this study,we aimed to explore how pIgR influences the secretion of regenerating islet-derived 3 beta(Reg3b)and the flora composition in AIH using in vivo experiments involving patients with AIH and a concanavalin A-induced mouse model of AIH.Reg3b expression was reduced in pIgR gene(Pigr)-knockout mice compared to that in wild-type mice,leading to increased microbiota disruption.Conversely,exogenous pIgR supplementation increased Reg3b expression and maintained microbiota homeostasis.RNA sequencing revealed the participation of the interleukin(IL)-17 signaling pathway in the regulation of Reg3b through pIgR.Furthermore,the introduction of external pIgR could not restore the imbalance in gut microbiota in AIH,and the decrease in Reg3b expression was not apparent following the inhibition of signal transducer and activator of transcription 3(STAT3).In this study,pIgR facilitated the upregulation of Reg3b via the STAT3 pathway,which plays a crucial role in preserving the balance of the intestinal microbiota in AIH.Through this research,we discovered new molecular targets that can be used for the diagnosis and treatment of AIH.

Immunoglobulin A glomerulonephropathy:A review

In this editorial,we comment on the article by Meng et al published in the World Journal of Clinical Cases.We comprehensively review immunoglobulin A nephro-pathy(IgAN),including epidemiology,clinical presentation,diagnosis,and management.IgAN,also known as Berger's disease,is the most frequent type of primary glomerulonephritis(GN)globally.It is mostly found among the Asian population.The presentation can be variable,from microscopic hematuria to a rapidly progressive GN.Around 50%of patients present with single or recurring episodes of gross hematuria.An upper respiratory infection and tonsillitis often precede these episodes.Around 30%of patients present microscopic hematuria with or without proteinuria,usually detected on routine examination.The diagnosis relies on having a renal biopsy for pathology and immunofluorescence microscopy.We focus on risk stratification and management of IgAN.We provide a review of all the landmark studies to date.According to the 2021 KDIGO(kidney disease:Improving Global Outcomes)guidelines,patients with non-variant form IgAN are first treated conservatively for three to six months.This approach consists of adequate blood pressure control,reduction of proteinuria with renin-angiotensin system blockade,treatment of dyslipidemia,and lifestyle modifications(weight loss,exercise,smoking cessation,and dietary sodium restrictions).Following three to six months of conservative therapy,patients are further classified as high or low risk for disease progression.High-risk patients have proteinuria≥1 g/d or<1 g/d with significant microscopic hematuria and active inflammation on kidney biopsy.Some experts consider proteinuria≥2 g/d to be very high risk.Patients with high and very high-risk profiles are treated with immunosuppressive therapy.A proteinuria level of<1 g/d and stable/im-proved renal function indicates a good treatment response for patients on immu-nosuppressive therapy.

Airway management of a patient with linear immunoglobulin A bullous dermatosis:A case report

BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.

Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level:A single-center,retrospective cohort study

BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.

Clinical characteristics and outcomes of autoimmune pancreatitis based on serum immunoglobulin G4 levels:A single-center,retrospective cohort study

Autoimmune pancreatitis(AIP)is a complex,poorly understood disease gaining increasing attention."Clinical Characteristics and Outcome of AIP Based on Serum IgG4 levels,"investigated AIP with a focus on serum immunoglobulin(Ig)G4 levels.The 213 patients with AIP were classified according to serum IgG4 levels:Abnormal(elevated)and normal.Patients with higher IgG4 levels exhibited a more active immune system and increased relapse rates.Beyond IgG4,the IgA levels and age independently contributed to relapse risk,guiding risk assessment and tailored treatments for better outcomes.However,limitations persist,such as no IgA correlation with IgG4 levels,absent data on autoantibodypositive AIP cases critical for Asian diagnostic criteria,and unexplored relapse rates in high serum IgG AIP by subtype.Genetic factors and family histories were not addressed.As the understanding and referral of seronegative AIPs increase,there's a growing need for commercially available,highly sensitive,and specific autoantibodies to aid in diagnosing individuals with low or absent serum IgG4 levels.

A Nested Case-Control Study to Explore the Association between Immunoglobulin G N-glycans and Ischemic Stroke

Objective This study prospectively investigates the association between immunoglobulin G(IgG)N-glycan traits and ischemic stroke(IS) risk.Methods A nested case-control study was conducted in the China suboptimal health cohort study,which recruited 4,313 individuals in 2013–2014. Cases were identified as patients diagnosed with IS, and controls were 1:1 matched by age and sex with cases. Ig G N-glycans in baseline plasma samples were analyzed.Results A total of 99 IS cases and 99 controls were included, and 24 directly measured glycan peaks(GPs) were separated from Ig G N-glycans. In directly measured GPs, GP4, GP9, GP21, GP22, GP23, and GP24 were associated with the risk of IS in men after adjusting for age, waist and hip circumference,obesity, diabetes, hypertension, and dyslipidemia. Derived glycan traits representing decreased galactosylation and sialylation were associated with IS in men(FBG2S2/(FBG2 + FBG2S1 + FBG2S2): odds ratio(OR) = 0.92, 95% confidence interval(CI): 0.87–0.97;G1n: OR = 0.74, 95% CI: 0.63–0.87;G0n: OR =1.12, 95% CI: 1.03–1.22). However, these associations were not found among women.Conclusion This study validated that altered Ig G N-glycan traits were associated with incident IS in men, suggesting that sex discrepancies might exist in these associations.

Immunoglobulin A vasculitis nephritis:Current understanding of pathogenesis and treatment

The clinical spectrum of immunoglobulin A vasculitis nephritis(IgAVN)ranges from the relatively common transitory microscopic hematuria and/or low-grade proteinuria to nephritic or nephrotic syndrome,rapidly progressive glomerulonephritis,or even renal failure.Clinical and experimental studies have shown a multifactor pathogenesis:Infection triggers,impaired glycosylation of IgA1,complement activation,Toll-like-receptor activation and B cell proliferation.This knowledge can identify IgAVN patients at a greater risk for adverse outcome and increase the evidence for treatment recommendations.

Infrequent organ involvement in immunoglobulin G4-related prostate disease: A case report

BACKGROUND Immunoglobulin G4-related prostate disease(IgG4-RPD)characterized by a high count of IgG4-positive plasma cells has distinctive serological and radiological findings.Here we report a case of a patient who was successfully treated for IgG4-RPD,which manifested as frequent micturition,dysuric,and systemic lymphadenopathy.CASE SUMMARY The patient was a 33-year-old man who was referred to our hospital because of urinary tract symptoms that had persisted for 4 years.A physical examination revealed systemic lymphadenopathy and blood tests showed hyperglobulinemia with an IgG level of 18.90 g/L and an IgG4 level of 18.40 g/L.Computed tomography(CT)revealed bilateral lacrimal gland,right parotid gland and prostatic enlargement.Based on these findings,IgG4-RD was suspected,and further pathological examination and follow-up results showed expected results.Finally,the patient was diagnosed with IgG4-RPD based on clinical symptoms,pathological examination,therapeutic effects,and follow-up results.He received 50 mg oral prednisolone(the dose was gradually reduced and a low dose was used for long-term maintenance)in combination with cyclophosphamide 1.0 g via an intravenous drip for 6 mo.One year after the treatment was initiated,he was free of urinary or other complaints and his serum IgG4 level normalized.CONCLUSION In IgG4-RPD with severe urinary tract symptoms,radiological findings should be carefully examined.IgG4-RPD prognosis is good because the disease responds well to glucocorticoids.Furthermore,it is urgent for clinicians and pathologists to improve their understanding of IgG4-RPD.

Novel COL4A3 synonymous mutation causes Alport syndrome coexistent with immunoglobulin A nephropathy in a woman:A case report

BACKGROUND Alport syndrome(AS)is an inherited disease of the glomerular basement membrane caused by mutations in genes encodingα3,α4,orα5 chains of type IV collagen.It manifests with hematuria or proteinuria,which is often accompanied by hearing impairments and ocular abnormalities.Histopathologically,AS shows mesangial proliferation and sometimes incidental immunoglobulin A(IgA)deposition.Hematuria or proteinuria is also a common presentation in patients with IgA nephropathy that makes it difficult to differentially diagnose AS and IgA nephropathy solely based on these clinical and pathological features.CASE SUMMARY Herein,we present the case of a 59-year-old female patient who was admitted to our hospital with persistent microscopic hematuria and occasional proteinuria that had lasted for>2 years.This patient had a familial history of renal disease and was diagnosed with autosomal dominant AS(ADAS)and IgA nephropathy based on the findings of renal biopsy as well as genetic testing performed using whole-exome sequencing,which suggested that the patient carried a novel heterozygous variation(c.888G>A:p.Gln296Gln)in the COL4A3 gene that enriches the mutation spectrum of ADAS.The proband received an angiotensin receptor blocker therapy after a definitive diagnosis was established.After one year of therapy,a significant reduction in proteinuria was observed.The number of microscopic red blood cells per high-power field decreased to one-quarter of the baseline levels.Renal function also maintained well during the follow-up.CONCLUSION Our case highlights the significance of performing kidney biopsy and genetic testing in the diagnosis of AS and familial IgA nephropathy.

益生菌制剂对抗生素诱导腹泻模型小鼠肠道菌群的调节作用

研究了益生菌制剂对腹泻模型(Antibiotic-Associated Diarrhea,AAD)小鼠肠道菌群的调节作用。BALB/c小鼠随机分为6组,每组8只,灌胃给予氨苄青霉素(22.4 g/kg),建立小鼠腹泻模型,空白组给予等体积生理盐水。模型建立后,阳性组灌胃给予培菲康(8 g/kg)、益生菌制剂低、中、高剂量组(2.5×10^(6)、5×10^(6)、1×10^(7) CFU)给予复合益生菌制剂,模型组和空白组给予等体积生理盐水,连续14 d。观察益生菌制剂对小鼠体质量、稀便率、稀便级和腹泻指数的影响,测定小鼠IgA、IgG水平,肠道屏障功能相关基因表达水平以及肠道菌群组成。结果表明,与模型组相比三个剂量组在给予益生菌第14天时小鼠稀便率、稀便级和腹泻指数显著降低,IgA水平分别提高13.30%、20.25%、25.83%,IgG水平分别提高6.84%、19.81%、29.64%,TLR4基因表达水平下调16.88%、20.78%、40.91%,NF-κB基因表达水平下调24.91%、37.19%、55.79%,肠道双歧杆菌、乳杆菌数量明显增加,产气荚膜梭菌、肠球菌、肠杆菌数量明显减少。综上所述,益生菌制剂通过调节肠道菌群,调节免疫球蛋白水平,发挥改善AAD作用。

沧州市中心医院2233例吸入性变应原血清学检测结果分析

目的回顾性分析2022年沧州市中心医院就诊患者的18种常见吸入性变应原的血清检测结果,了解该地区吸入性变应原的流行情况,为过敏性疾病的预防、诊断和治疗提供依据。方法以沧州市中心医院2022年1~12月进行变应原sIgE检测的2233例患者为研究对象,对患者变应原情况进行统计分析。结果吸入性变应原sIgE阳性率为59.43%,前5位的吸入性变应原依次为粉尘螨(28.08%)、屋尘(23.20%)、屋尘螨(22.21%)、艾蒿(16.44%)和猫上皮(12.32%)。男性和女性患者各类变应原阳性率均无显著性差异(P>0.05)。不同年龄组的阳性率差异具有统计学意义(P<0.01),其中1~10岁组的阳性率最高。除1~10岁组中阳性率最高的吸入性变应原为屋尘以外,其他年龄组阳性率最高的变应原均为粉尘螨。秋季就诊的阳性检出率最高。结论沧州地区疑诊过敏性疾病患者变应原sIgE阳性主要变应原为粉尘螨、屋尘、屋尘螨、艾蒿和猫上皮。变应原sIgE阳性检出率在不同季节、不同年龄段患者中存在明显差异,不同性别患者的变应原sIgE阳性率无显著差异。研究结果可以为河北沧州地区过敏性疾病的防治提供重要参考。

成人支气管哮喘患者血清总IgE和过敏原特异性IgE检测结果分析

目的探讨成人支气管哮喘患者过敏原总免疫球蛋白E(tlgE)和特异性免疫球蛋白E(sIgE)的分布特征,以期为准确识别和区分过敏性哮喘患者提供帮助。方法选取2020年1月至2022年12月就诊于北京朝阳医院京西院区呼吸科临床诊断为支气管哮喘疾病的成人患者717例,应用德国西门子公司(Siemens)全自动特定蛋白仪BN II和瑞典Phadia AB公司Phadia 250全自动荧光酶联免疫分析系统分别检测患者血清tlgE和过敏原sIgE,对血清tlgE和sIgE检测结果进行回顾性分析。结果成人支气管哮喘患者tlgE和sIgE的总阳性率分别为50.5%和34.4%。室内过敏原比食物过敏原更常见。过敏原slgE阳性率前3位依次为户尘螨(d1)、霉菌和酵母组合2(mx2)和狗皮屑(e5);致敏重度率前3位的为e5、食物组合5(fx5)和d1。对于e5和mx2,男性sIgE阳性率明显高于女性(P<0.05),青年组明显高于老年组(P<0.05)。多重过敏患者占sIgE的阳性患者的66%,青年组和老年组较中年组更为常见。d1阳性样本中合并至少其他一种过敏原的患者占到87.1%。结论检测支气管哮喘患者血清tlgE和sIgE水平,有助于区分和鉴别过敏性哮喘。研究发现,在成人过敏原阳性患者中,d1、mx2、e5为最主要的吸入性过敏原。青年男性是更易致敏的人群;青年和老年群体通常会出现多重致敏的现象。

母女同患紫癜性肾炎合并Alport综合征1家系报道

过敏性紫癜(henoch-schonlein purpura,HSP)又称IgA血管炎,是儿童常见的系统性血管炎疾病之一,本病多为自限性疾病、预后相对较好。HSP累及肾脏即为紫癜性肾炎(henoch schonlein purpura nephritis,HSPN),又称IgA血管炎肾炎,是儿科临床肾脏专业常见的继发性肾小球疾病之一[1-4]。

百令胶囊联合常规西药治疗免疫球蛋白A肾病患者的临床疗效及对其炎性因子的影响

目的 探讨百令胶囊联合常规西药治疗免疫球蛋白A(Immunoglobulin A,IgA)肾病患者的临床疗效及对其炎性因子的影响。方法 选取2019年6月—2021年6月期间自贡市第一人民医院收治的IgA肾病患者94例,按照随机数字表法分为对照组和观察组,每组各47例。对照组采用他克莫司和甲泼尼龙片等常规治疗方案,观察组在对照组基础上加用百令胶囊治疗。均治疗3个月。观察比较两组患者肾功能指标[血浆白蛋白(Albumin,ALB)、血肌酐(Serum creatinine,SCr)、血尿素氮(Blood urea nitrogen,BUN)、24 h尿蛋白(24 hours urine protein,TUP)]和血脂指标[甘油三酯(Triglyceride,TG)、高密度脂蛋白(High-density lipoprotein,HDL-C)、低密度脂蛋白(Low-density lipoprotein,LDL-C)、总胆固醇(Cholesterol total,TC)]水平,炎性因子[干扰素-γ(Interferon γ,IFN-γ)、白细胞介素17(Interleukin 17,IL17)、转化生长因子β1(Transforming growth factor-β,TGF-β1)]水平、外周血细胞免疫水平(T细胞亚群CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、临床疗效及不良反应情况。结果 治疗后观察组总有效率93.62%(44/47)明显高于对照组74.47%(35/47),差异有统计学意义(P<0.05)。治疗后两组患者SCr、BUN、24 h TUP和LDL-C、TG、TC水平均较治疗前降低,ALB、GFR和HDL-C水平均较治疗前升高,差异有统计学意义(P<0.05);且观察组BUN、SCr、24 h TUP和LDL-C、TG、TC水平均明显低于对照组,ALB、GFR、HDL-C均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者炎症因子TGF-β1、IL-17、IFN-γ水平均较治疗前降低,差异有统计学意义(P<0.05);观察组炎症因子TGF-β1、IL-17、IFN-γ水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者免疫指标CD4^(+),CD4^(+)/CD8^(+)水平均较治疗前升高,CD8^(+)水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组免疫指标CD4^(+),CD4^(+)/CD8^(+)均明显高于对照组,CD8^(+)水平明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(χ^(2)=0.617,P=0.432)。结论 在他克莫司和甲泼尼龙片基础上联合百令胶囊治疗IgA肾病有助于改善肾功能、血脂指标,提高临床有效率,降低炎性因子水平,且安全性良好。

化瘀去疣汤内服外用治疗对扁平疣患者中医证候、血清免疫球蛋白及复发的影响

目的:探讨化瘀去疣汤内服外用治疗对扁平疣患者中医证候、血清免疫球蛋白及复发的影响。方法:选取2021年8月~2023年8月收治的132例扁平疣患者,按照随机数表法分为观察组和对照组各66例,对照组采用常规药物治疗,观察组在对照组的基础上采用化瘀去疣汤内服外用治疗,比较两组临床疗效、中医证候积分(皮疹颜色、瘙痒感、身热口干、便干尿黄)、血清免疫球蛋白[IgG、IgA、IgM]、免疫细胞因子[IL-2、IL-10、IFN-γ]及复发率。结果:观察组总有效率高于对照组(P<0.05);治疗后,观察组的中医症候积分(皮疹颜色、瘙痒感、身热口干、便干尿黄)低于对照组(t=6.114;t=5.552;t=6.705;t=5.435,P<0.05);治疗后,观察组血清IgG、IgA、IgM水平高于对照组(t=4.056;t=3.630;t=5.918,P<0.05);治疗后,观察组血清IFN-γ、IL-2高于对照组,IL-10低于对照组(t=9.462;t=5.429;t=8.314,P<0.05);随访6个月,观察组复发率低于对照组(4.55%vs 16.67%,χ2=5.114,P<0.05)。结论:化瘀去疣汤内服外用治疗扁平疣患者的效果显著,可有效提高免疫球蛋白水平,改善免疫细胞因子,降低复发率。

2型糖尿病患者糖化血红蛋白与血清炎症指标、免疫球蛋白水平的相关性研究

目的 探究2型糖尿病患者糖化血红蛋白水平与血清炎症指标、免疫球蛋白水平的相关性。方法 选择2022年1—9月期间到福州市第二医院就诊的50例2型糖尿病患者作为研究对象,均进行糖化血红蛋白、炎症指标、免疫球蛋白检测。同时根据患者糖化血红蛋白水平分为A组(糖化血红蛋白<7.5%,n=15)、B组(糖化血红蛋白7.5%~9.0%,n=20)、C组(糖化血红蛋白>9.0%,n=15),比较各组检测结果,并分析炎症指标、免疫球蛋白与糖化血红蛋白水平的相关性。结果 C组的超敏C反应蛋白(Hypersensitive C-reactive Protein, hsCRP)、白介素-6(Interleukin-6, IL-6)、肿瘤坏死因子-α(Tumor Necrosis Factor-α, TNF-α)、免疫球蛋白A(Immunoglobulin A, IgA)水平显著高于B组、A组,差异有统计学意义(P均<0.05)。C组免疫球蛋白G(Immunoglobulin G, IgG)水平明显低于B组、A组,差异有统计学意义(P均<0.05)。B组的hs-CRP、IL-6、TNF-α、IgA水平明显高于A组,IgG水平明显低于A组,差异有统计学意义(P均<0.05)。Pearson相关系数分析显示,hs-CRP、IL-6、TNF-α、IgA与糖尿病患者糖化血红蛋白水平呈正相关性,IgG与糖化血红蛋白水平呈负相关(P<0.05),而免疫球蛋白M(Immunoglobulin M, IgM)水平与糖化血红蛋白水平无相关性(P>0.05)。结论 2型糖尿病患者存在hs-CRP、IL-6、TNF-α及IgA、IgG异常,与糖化血红蛋白水平呈明显相关性,因此对于糖化血红蛋白异常升高者,需密切监测上述炎症、免疫球蛋白指标,便于临床及早发现患者机体异常,及时干预。

血清IgG4临床分布特征及在IgG4相关性疾病诊断中的价值

目的:探讨血清免疫球蛋白G4(IgG4)临床分布特征及在IgG4相关疾病(IgG4-RD)中的诊断价值。方法:回顾性分析2018年1月—2021年12月菏泽市立医院1256例患者的临床资料,均采用增强型免疫散射法对其血清标本中的IgG4进行检测,根据测定结果和临床其他相关诊断标准,将1256例患者分为研究A组(均为IgG4-RD患者,19例)和研究B组(均为非IgG4-RD患者,1237例),利用受试者工作特征(ROC)曲线分析IgG4在IgG4-RD患者中的诊断价值;对非IgG4-RD患者按照疾病类型进行分组,比较不同疾病类型的IgG4检测水平和阳性检出率。结果:研究A组血清IgG4水平高于研究B组(P<0.05);研究A组IgG4阳性检出占比100%,高于研究B组的12.37%(P<0.05)。经ROC曲线分析显示,取最优约登指数0.899时,IgG4诊断IgG4-RD的敏感度为92.05%,特异度为89.14%,曲线下面积(AUC)为0.919[95%CI(0.879,0.965)],最佳临界值为1.95 g/L。研究B组不同疾病类型之间IgG4水平差异均有统计学意义(P<0.05),其中以肿瘤相关疾病和自身免疫疾病患者IgG4水平最高;而不同疾病类型之间IgG4阳性检出率比较差异无统计学意义(P>0.05)。结论:IgG4-RD患者多伴有血清IgG4表达异常升高的现象,可累及多组织器官;以1.95 g/L为临界值则可以提高疾病诊断的敏感度和特异度;但为了区分IgG4-RD和肿瘤相关疾病和自身免疫疾病还需结合其他临床诊断加以鉴别。

外周血指标对鼻息肉患者黏膜中IL-5和金黄色葡萄球菌肠毒素特异性免疫球蛋白E阳性表达的预测价值

目的借助外周血指标预测慢性鼻窦炎伴鼻息肉(CRSwNP)2型生物标志物。方法收集2020年6月~2022年5月在北京同仁医院鼻科住院的CRSwNP患者临床资料,检测外周血中嗜酸粒细胞百分比(Eos%)、Eos计数、骨膜蛋白和总IgE以及CRSwNP黏膜中白细胞介素5(IL-5)和金黄色葡萄球菌肠毒素特异性免疫球蛋白E(Staphylococcus aureus enterotoxinimmunoglobulin E,SE-IgE)。应用受试者工作特征(ROC)曲线评估每个外周血指标对黏膜IL-5/SE-IgE阳性表达预测价值,利用Logistic回归筛选对黏膜IL-5/SE-IgE阳性有预测价值的外周血指标,构建诺模图模型。结果CRSwNP患者哮喘比例、血中Eos%、骨膜蛋白和总IgE在IL-5/SE-IgE阳性和阴性两组之间,均具有统计学差异。ROC曲线单因素分析显示血Eos%、Eos计数、骨膜蛋白和总IgE对黏膜IL-5和SE-IgE阳性预测的AUC分别波动在0.655~0.784和0.721~0.802,Logistic回归确认血中Eos%、总IgE和血中骨膜蛋白、总IgE可分别作为IL-5和SE-IgE阳性的独立预测因素。构建预测CRSwNP黏膜IL-5/SE-IgE阳性的诺模图模型,一致性指数(C-index)为0.804和0.81,提示具有很好的预测准确性。结论血中Eos%、总IgE和血中骨膜蛋白、总IgE分别构建的诺模图,对CRSwNP黏膜IL-5和SE-IgE阳性表达具有很好的预测价值,可以预判CRSwNP内型和表型严重性。