血清IgG4、CA19-9水平对IgG4相关性胆管炎的诊断及鉴别诊断价值  

Significance of serum IgG4 and CA19-9 in diagnosis and antidiastole of IgG4 related cholangitis

作　　者：谭立明[1] 管晓琳 吴思凡 郑葳 付慧颖 蒙仪妹 隆婷婷 王巧花 吴洋[1] 曾婷婷[1] 田永建[1] 余建林[1] 陈娟娟[1] 李华[1] 曹莉萍[1] 徐慧 TAN Li-Ming,;GUAN Xiao-Lin;WU Si-Fan;ZHENG Wei;FU Hui-Ying;MENG Yi-Mei;LONG Ting-Ting;WANG Qiao-Hua;WU Yang;ZENG Ting-Ting;TIAN Yong-Jian;YU Jian-Lin;CHEN Juan-Juan;LI Hua;CAO Li-Ping;XU Hui(Department of Clinical Laboratory,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院检验科,南昌330006 [2]南昌大学公共卫生学院,南昌330006

出　　处：《中国免疫学杂志》2018年第3期431-435,共5页Chinese Journal of Immunology

基　　金：本文为江西省科技计划项目(20151BBI90047,20171BAB205076)

摘　　要：目的:探讨血清IgG4、CA19-9及自身抗体对IgG4相关性胆管炎(IgG4-SC)的诊断及鉴别价值。方法:选取41例IgG4-SC患者、162例非IgG4-SC患者及40例健康对照血清样本,采用免疫比浊法和直接化学发光法检测IgG4和CA19-9水平、采用间接免疫荧光法检测抗核抗体(ANA)、抗中性粒细胞胞浆抗体(ANCA)、抗平滑肌抗体(SMA)和抗线粒体抗体(AMA),并进行结果统计分析。结果:(1)IgG4-SC患者的ANA、ANCA、SMA和AMA阳性率分别为41.46%、7.32%、0和2.44%。其中,ANA阳性率与正常对照组、ANCA阳性率与原发性硬化性胆管炎(PSC)组、SMA和AMA阳性率与非IgG4-SC组均存在差异,且具有非常显著统计学意义(P<0.01)。(2)血清IgG4(n=36/41)和CA19-9(n=21/41)升高情况与正常对照组相比,差异具有统计学意义(P<0.01);其ROC曲线下面积(AUC)分别为0.979和0.646,P<0.05。结论:血清IgG4和CA19-9水平的高表达和自身抗体检测,对于IgG4-SC的鉴别诊断具有准确性和重要临床价值。Objective:To investigate the value of autoantibodies and serum levels of IgG4 and CA19-9 in the diagnosis of IgG4 associated cholangitis(IgG4-SC).Methods:Detect the serum IgG4 and CA19-9 of 41 clinical cases of IgG4-SC patients,162 clinical cases of non IgG4-SC patients and 40 healthy human serum samples by immunoassay and direct chemiluminescence methods,also detect the antinuclear antibodies(ANA),anti neutrophil antibody(ANCA),anti smooth muscle antibody(SMA)and anti mitochondrial antibody(AMA)of the above serum samples by indirect immunofluorescence and analyze the detection results.Results:①The positive rates of ANA,ANCA,SMA and AMA in patients with IgG4-SC were 41.46%,7.32%,0 and 2.44%.Among them,the positive rate of ANA was significantly different from that of the normal control group(P<0.01),and the positive rate of SMA and AMA was significantly different from that of non IgG4-SC group(P<0.01),and so as the positive rate of ANCA do with that of PSC group.②The number of serum IgG4 and CA19-9 increased samples were significantly compared with the normal control group(P<0.01);the area under the ROC curve(AUC)was 0.979 and 0.646,respectively,and P<0.05.Conclusion:The high level of serum IgG4 and CA19-9 and autoantibody detection are of great accuracy and important clinical value in the differential diagnosis of IgG4-SC.

关 键 词：IgG4相关性胆管炎 原发性硬化性胆管炎 胆管癌 胰腺癌 IGG4 CA19-9 抗核抗体(ANA) 抗中性粒细胞胞浆抗体(ANCA) 抗平滑肌抗体(SMA) 抗线粒体抗体(AMA) 

分 类 号：R446.61[医药卫生—诊断学]