识别自身免疫性胰腺炎的哨兵指标——高γ球蛋白血症  

Hypergammaglobulinemia： a sentinel detecting autoimmune pancreatitis

作　　者：吴文川[1] 姚秀忠[2] 靳大勇[1] 王单松[1] 楼文晖[1] 秦新裕[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032 [2]复旦大学附属中山医院放射科,上海200032

出　　处：《中华普通外科杂志》2013年第1期20-23,共4页Chinese Journal of General Surgery

基　　金：上海市科委基础研究重点项目（11JCl402502）、上海市级医院新兴前沿技术项目（项目编号SHDCl2010120）

摘　　要：目的筛选可识别自身免疫性胰腺炎（autoimmune pancreatitis，AIP）的哨兵指标，降低恶性肿瘤的误诊率。方法回顾性分析4年来中山医院普外科住院治疗的AIP相关的病例共14例。所有患者都进行肝功能、CAl99以及增强CT和（或）MRI的常规检查，临床上疑似AIP或者病理已证实AIP者，则进行IgG或IgG4的检测。比较研究AIP患者与非AIP患者之间临床特征的区别。结果10例患者最终确诊为AIP。AIP患者CAl99可以是正常或轻度升高，低于非AIP患者CAl99的数值（P=0．041）。所有AIP患者的血清γ球蛋白比例均升高，而非AIP患者仅有25％出现γ球蛋白升高，差异有统计学意义（P=0．011）。AlP患者的IgG、IgG4升高比例均为100％，而非AIP患者分别为25％（P=0．024）和0％（P=0．048）。结论高γ球蛋白血症是术前识别AIP的哨兵指标。拟诊胰腺癌患者若出现γ球蛋白比例升高，可进一步检查血清IgG或IgG4，以识别AIP，避免不必要的手术治疗。Objective To determine the clinical value of hypergammaglobulinemia as a sentinel for autoimmune pancreatitis and avoid unnecessary pancreas resection. Methods All 14 patients with autoimmune pancreatitis or related pancreatic diseases underwent routine examinations, including liver function, CA199 and imaging. Measurement of serum IgG or IgG4 was performed for patients with clinically suspected or pathologically proved autoimmune pancreatitis. Clinical features were retrospectively compared between the AIP and non-AlP patients using X2 statistics with Yates correction or Fisher exact test. Results Ten cases were finally confirmed as autoimmune pancreatitis. All patients with autoimmune pancreatitis had elevated levels of serum r-globulins, while only one case without autoimmune pancreatitis had elevated levels of serum rglobulins. It was proved by subsequent antibody tests that serum IgG/IgG4 and r-globulins were simultaneously increased. Conclusions Hypergammaglobulinemia can be used as a preoperative sentinel indicator for differentiating autoimmune panereatitis from pancreatic malignancies and avoiding unnecessary pancreas operation.

关 键 词：胰腺炎 自身免疫疾病 高丙种球蛋白血症 诊断 

分 类 号：R593.2[医药卫生—内科学]