血清IgG_(4)临床分布特征及在IgG_(4)相关性疾病诊断中的作用  

Clinical distribution characteristics of serum immunoglobulin IgG_(4)and its diagnostic value in IgG_(4)related diseases

作　　者：冯月宁 韩志城 谢宇瑞 安阿玥[1] Feng Yuening;Han Zhicheng;Xie Yurui;An Ayue(Department of Analogy,Wangjing Hospital,Chinese Academy of Traditional Chinese Medicine,Beijing 100102,China;Laboratory Department of Wangjing Hospital,Chinese Academy of Traditional Chinese Medicine,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院肛肠科,北京100102 [2]中国中医科学院望京医院检验科,北京100102

出　　处：《国际免疫学杂志》2022年第6期583-588,共6页International Journal of Immunology

基　　金：中国中医科学院科技创新工程课题(CI2021A02102)。

摘　　要：目的探讨血清免疫球蛋白G_(4)(immunoglobulin G_(4),IgG_(4))分布特征及在IgG_(4)相关疾病(IgG_(4)-related diseases,IgG_(4)-RD)中的诊断价值。方法回顾性分析2018年1月至2021年12月间中国中医科学院望京医院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IgG_(4)进行检测,根据测定结果和临床其他相关诊断标准,将1256例患者分为研究组1(均为IgG_(4)-RD患者,19例)和研究组2(均为非IgG_(4)-RD患者,1237例),利用受试者工作特征(receiver operating characteristic,ROC)曲线分析IgG_(4)在IgG_(4)-RD患者中的诊断价值;对非IgG_(4)-RD患者按照疾病类型进行分组,比较不同组别IgG_(4)检测水平和阳性检出率。结果研究组1血清IgG_(4)水平及阳性检出率均高于研究组2[g/L:(2.75±0.54)比(0.79±0.20),94.74%比12.37%,t=40.60,χ^(2)=107.95,P值均<0.05]。ROC曲线分析显示,以1.35 g/L为临界值,IgG_(4)诊断IgG_(4)-RD的灵敏度为90.63%、特异度75.95%,尤登指数为0.80;而取最优尤登指数0.90时,IgG_(4)诊断IgG_(4)-RD的灵敏度为92.05%、特异度89.14%,曲线下面积(area under curve,AUC)为0.92,95%CI为0.88~0.97,最佳临界值为1.95 g/L。研究组2不同疾病类型之间IgG_(4)水平差异有统计学意义(P<0.05),其中以肿瘤相关疾病和自身免疫疾病患者IgG_(4)水平最高;而不同疾病类型之间IgG_(4)阳性检出率比较差异无统计学意义(P>0.05)。结论IgG_(4)-RD患者多伴有血清IgG_(4)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灵敏度和特异度。Objective To investigate the clinical distribution of serum immunoglobulin G_(4)(IgG_(4))and its diagnostic value in IgG_(4)-related diseases(IgG_(4)-RD).Methods The clinical data of 1256 patients from January 2018 to December 2021 in Chinese Academy of Traditional Chinese Medicine were retrospectively analyzed.IgG_(4)in serum samples was detected by enhanced immune scattering method.According to the measurement results and other clinical diagnostic criteria,1256 patients were divided into study group 1(IgG_(4)-RD patients,19 cases)and study group 2(non IgG_(4)-RD patients,1237 cases),the diagnostic value of IgG_(4)in patients with IgG_(4)-RD was analyzed by receiver operating characteristic(ROC)curve.Non IgG_(4)-RD patients were divided into groups according to the type of disease,and the detection level and positive detection rate of IgG_(4)in different groups were compared.Results The IgG_(4)level and positive detection rate in study group 1 were higher than those in study group 2[g/L:(2.75±0.54)vs(0.79±0.20),94.74%vs 12.37%,t=40.60,χ^(2)=107.95,both P values<0.05].ROC curve analysis showed that the sensitivity,specificity and Youden index of IgG_(4)in the diagnosis of IgG_(4)-RD were 90.63%,75.95%and 0.80 based on 1.35 g/L ascritical value.When the optimal Youden index was 0.90,the sensitivity and specificity of IgG_(4)in diagnosing IgG_(4)-RD are 92.05%,89.14%,area under curve(AUC)is 0.92,95%CI is 0.88~0.97,and the optimal critical value was 1.95 g/L.The difference of IgG_(4)level between different disease types in study group 2 was statistically significant(P<0.05).There was no significant difference in the positive rate of IgG_(4)among different disease types(P>0.05).Conclusion IgG_(4)-RD patients are often accompanied by abnormal increase of serum IgG_(4)expression,which may involve multiple tissues and organs.Taking 1.95 g/L as the critical value may improve the sensitivity and specificity of disease diagnosis.However,in order to distinguish IgG_(4)-RD from tumor related diseases and autoimmune diseas

关 键 词：免疫球蛋白G_(4) IgG_(4)相关疾病 临床分布特征 诊断价值 

分 类 号：R446.6[医药卫生—诊断学] R593.2[医药卫生—临床医学]