IgG4相关性肺疾病临床特征研究  

Clinical features of IgG4-related lung disease

作　　者：张文[1,4] 张茉沁 公丕花[1] 潘峰[2] 孙昆昆[3] 暴婧[1] 李玉茜[1] 高占成[1] Zhang Wen;Zhang Moqin;Gong Pihua;Pan Feng;Sun Kunkun;Bao Jing;Li Yuqian;Gao Zhancheng(Department of Respiratory and Critical Care Medicine,Peking University People′s Hospital,Beijing 100044,China;Department of Radiology,Peking University People′s Hospital,Beijing100044,China;Department of Pathology,Peking University People′s Hospital,Beijing 100044,China;Department of Respiratory and Critical Care Medicine,Ningde Municipal Hospital of Ningde Normal University,Ningde 352199,China)

机构地区：[1]北京大学人民医院呼吸与危重症医学科,北京100044 [2]北京大学人民医院放射科,北京100044 [3]北京大学人民医院病理科,北京100044 [4]宁德师范学院附属宁德市医院呼吸与危重症医学科,宁德352199

出　　处：《中华医学杂志》2023年第18期1417-1422,共6页National Medical Journal of China

摘　　要：目的分析IgG4相关性肺疾病的临床特征。方法回顾性收集2012年2月至2021年5月于北京大学人民医院诊断为IgG4相关性肺疾病60例的患者临床资料,对其临床表现、实验室检查、影像学、预后等特征进行分析。结果60例患者中,男40例,年龄(58.2±12.9)岁,发病年龄(57.1±13.2)岁,31.7%(19例)患者有过敏疾病史。36.7%(22例)患者病程中出现呼吸系统症状。94.6%(53/56)患者血清IgG4>1.35 g/L,24.1%(14/58)患者嗜酸性粒细胞绝对值升高,79.2%(38/48)患者IgE升高,53.7%(29/54)患者补体C3或C4下降。常见影像学表现包括结节样改变38例(63.3%),纵隔和(或)肺门淋巴结肿大34例(56.7%),磨玻璃影31例(51.7%),53例(88.3%)患者存在2种及以上影像学改变。病理学检查以淋巴浆细胞浸润及纤维增生为主要表现,仅1例可见闭塞性静脉炎。有呼吸系统症状组(22例)血清总IgG(及嗜酸性粒细胞绝对值)均高于无症状组(38例),分别为43.2比17.8 g/L和0.30×109/L比0.14×109/L,均P<0.05;合并过敏性疾病比例低于无症状组,胸部CT存在实变影比例高于无症状组,均P<0.05;两组血清IgG4、IgE、补体水平及治疗后影像学转归情况差异均无统计学意义(均P>0.05)。结论IgG4相关性肺疾病临床表现无特异性,无呼吸系统症状患者占较高比例;胸部CT表现具有高度异质性,且易出现多种影像学改变共存。有无呼吸系统症状组患者主要临床特征及治疗后影像学转归差别不大。Objective To explore the clinical features of IgG4-related lung disease.Methods The clinical data of 60 patients diagnosed with IgG4-related lung disease in Peking University People′s Hospital from February 2012 to May 2021 were retrospectively collected.Analysis was made to explore the features of clinical manifestation,laboratory,imaging,prognosis and other characteristics of the disease.Results A total of 60 patients were included,with 40 males,age of(58.2±12.9)years,an age of onset of(57.1±13.2)years,and 31.7%(19 cases)of the patients had a history of allergic disease.36.7%(22 cases)of the patients had respiratory symptoms during the disease.94.6%(53/56)of patients had serum IgG4>1.35 g/L,24.1%(14/58)of patients had increased eosinophils,79.2%(38/48)of patients had increased IgE level,and 53.7%(29/54)of patients had decreased C3 or C4.Common imaging findings included nodular changes(38 cases,63.3%),mediastinal and/or hilar lymphadenopathy(34 cases,56.7%),and ground glass opacities(31 cases,51.7%).Fifty-three cases(88.3%)showed two or more imaging changes.The pathological examination of the patient was mainly characterized by lymphoplasmacytic infiltration and fibrosis,with only one case of phlebitis obliterans.Compared with the asymptomatic group(38 cases),patients with respiratory symptoms(22 cases)showed higher level of serum total IgG and eosinophils(43.2 vs 17.8 g/L,0.30×109/L vs 0.14×109/L,P<0.05),lower proportion of allergic diseases,and higher proportion of consolidation shadows on chest CT(P<0.05).There were no significant differences in serum IgG4,IgE,complement levels,and imaging outcomes after treatment between the two groups(P>0.05).Conclusions The clinical manifestations of IgG4-related lung disease are atypical,and asymptomatic patients account for a high proportion.The imaging of the disease is highly heterogeneous,and patients are prone to show coexisted multiple imaging changes.The main clinical features and imaging outcomes of patients with and without respiratory symptoms are not sign

关 键 词：免疫球蛋白G 肺疾病 临床特征 影像学 治疗 横断面研究 

分 类 号：R563[医药卫生—呼吸系统]