自身免疫性胰腺炎患者血清IgG亚型特征及鉴别诊断  

Serum IgG subtypes features and differential diagnosis of autoimmunepancreatitis patients

作　　者：邸平[1] 孙京花 朱剑[2] 王珊珊[1] 徐菡[1] 王成彬[1] 李健[1] 

机构地区：[1]解放军总医院临检科,北京100853 [2]解放军总医院风湿免疫科,北京100853

出　　处：《中华医学杂志》2016年第8期646-649,共4页National Medical Journal of China

摘　　要：摘要 目的探讨血清免疫球蛋白G（IgG）亚型分布对罕见自身免疫性胰腺炎鉴别诊断的临床价值。 方法选择2013年1月至2014年1月解放军总医院自身免疫性胰腺炎患者28例、急慢性胰腺炎患者112例、胰腺癌患者15例、胆管癌患者9例、腹膜后纤维化患者37例及健康对照者52名，分别检测其IgG亚型、淀粉酶、脂肪酶、血糖、人糖链抗原19－9 （CA19－9）水平，并对难以鉴别的自身免疫性胰腺炎和胰腺癌患者进行腹部CT和病理学组化染色检查，分别比对分析。 结果自身免疫性胰腺炎组、急慢性胰腺炎组、胰腺癌组、胆管癌组、健康对照组IgG4水平分别为7.6（1.7～13.8）、0.4（0.2～0.7）、0.7（0.2～0.9）、0.5（0.4～6.5）、0.4（0.2～0.7）g/L，差异有统计学意义（H＝40.536，P〈0.001）。自身免疫性胰腺炎组、腹膜后纤维化组、健康对照组间IgG1、IgG3水平差异均无统计学意义（均P〉0.05）；而IgG4水平分别为7.6（1.7～13.8）、1.3（0.5～2.6）、0.4（0.2～0.7）g/L，差异有统计学意义（H＝36.833, P〈0.001），腹膜后纤维化组IgG4水平低于自身免疫性胰腺炎组，差异有统计学意义（P〈0.05），可用于鉴别诊断。 结论血清IgG亚型检测对自身免疫性胰腺炎与相似疾病的鉴别诊断具有重要意义，有助于减少误诊误治。ObjectiveTo investigate clinical value of serum IgG subclass distribution in differential diagnosis of autoimmune pancreatitis. MethodsInpatients were enrolled as follow, autoimmune pancreatitis （AIP, n=28）, acute and chronic pancreatitis （ACP, n=112）, pancreatic cancer （PC, n=15）, cholangiocarcinoma （CC, n=9）, retroperitoneal fibrosis （RPF, n=37）, together with healthy controls （n=52）. IgG subtypes, amylase, lipase, glucose and CA19-9 were tested.For patients with autoimmune pancreatitis and pancreatic cancer, radiographic CT of abdomen and pathological staining were included for comparison. ResultsIgG4 subtype distributed in a wide range as 7.6（1.7-13.8）g/L in AIP, 0.4（0.2-0.7）g/L in ACP, 0.7（0.2-0.9）g/L in PC, 0.5（0.4-6.5）g/L in CC and 0.4（0.2-0.7）g/L in control group, the difference was significant（H=40.536, P〈0.001）. There were no significant differences of IgG1, IgG3 level in AIP , RPC and control group（all P〉0.05）. While IgG4 level was 7.6（1.7-13.8）, 1.3（0.5-2.6）, 0.4（0.2-0.7）g/L in AIP , RPC and control group, respectively. The difference was significant（H=36.833, P〈0.001）. IgG4 level in RPC group was lower than that in AIP group（P〈0.05）. And it was meaningful in the differential diagnosis. ConclusionSerum IgG4 subtype plays an important role in differentiation of autoimmune pancreatitis from associated diseases.

关 键 词：免疫球蛋白G 胰腺炎 诊断 鉴别 

分 类 号：R576[医药卫生—消化系统]