IgG4升高的疾病分布及其诊断效能与致病相关因素的分析  

Analysis of the distribution,diagnostic efficacy,and pathogenic factors of IgG4 elevated diseases

作　　者：罗微[1] 张伟峰 郝天琪 黄煦 武昊 董莉真 贾子超[1] 袁纯辉 董作亮[1] Luo Wei;Zhang Weifeng;Hao Tianqi;Huang Xu;Wu hao;Dong Lizhen;Jia Zichao;Yuan Chunhui;Dong Zuoliang(Department of Clinical Laboratory,Tianjin Medical University General Hospital,Tianjin 300052,China;Biochemistry and Molecular Biology Laboratory,Qilu Medical College,Shandong University,Shandong,Jinan 250012;School of Medical Imaging,Tianjin Medical University,Tianjin 300203;Department of Laboratory Medicine,Wuhan Children’s Hospital,Huazhong University of Science and Technology,Wuhan 430016,China)

机构地区：[1]天津医科大学总医院医学检验科,天津300052 [2]山东大学齐鲁医学院生物化学与分子生物学实验室,济南250012 [3]天津医科大学医学影像学院,天津300203 [4]华中科技大学同济医学院附属武汉儿童医院检验部,武汉430016

出　　处：《国际免疫学杂志》2023年第4期363-370,共8页International Journal of Immunology

基　　金：国家自然科学基金青年项目(82202536);天津医科大学总医院青年孵育基金(ZYYFY2016024);天津医科大学总医院新世纪人才计划(209060102501)。

摘　　要：目的调查免疫球蛋白G4(immunoglobulin,IgG4)升高患者的疾病分布及血清IgG4水平,筛选适用于本地区人群的临界值(cut off,Cut-off);分析幽门螺杆菌(Helicobacter pylori,Hp)、结核(Tuberculosis,TB)感染与血清IgG4水平升高的相关性。方法选取天津医科大学总医院2018年1月至2020年12月进行血清IgG4检测的标本,C^(13)呼气试验检测Hp,结核斑点实验(Tuberculosis spot,T-spot)实验检测TB。血清IgG4水平采用独立样本t检验,双侧检验P<0.05认为有统计学意义。结果在2139份血清IgG4升高的标本中有33.29%(712/2139)来自IgG4相关性疾病(IgG4-related disease,IgG4-RD)患者,18.51%(396/2139)来自自身免疫性疾病(autoimmune disease,AID)患者,其余48.20%(1031/2139)为其它疾病,各组间血清IgG4水平没有统计学差异(P>0.05)。IgG4-RD组单器官累及最多的是胆囊,AID中最常见的是自身免疫性胰腺炎,其它疾病中最常见的是消化系统疾病。采用国际标准IgG4>1.35 g/L诊断时的灵敏度和特异度分别是81.00%和82.48%,本研究的最佳诊断cut-off值是1.23 g/L,此时灵敏度和特异度分别为84.19%和80.62%。Hp或TB感染患者的血清IgG4水平与未感染者的并无显著性差异。结论IgG4升高的病例中,IgG4-RD是最为常见,但各种AID和消化系统疾病等也会导致IgG4升高。本地区IgG4诊断最佳cut-off值是1.23 g/L,与国际推荐的1.35 g/L存在差别,采用国际标准可能造成在灰区漏诊。本研究不支持Hp和TB会导致血清IgG4水平升高的观点。Objectives To make the epidemiological classification of diseases and statistical analysis of serum immunoglobulin G4(IgG4)level in patients with elevated serum IgG4,and compare the diagnostic efficacy with the existing diagnostic criteria(IgG4>1.35 g/L),to find out the cut-off value suitable for the local population and to analyze whether Helicobacter pylori(Hp)and Tuberculosis(TB)will lead to elevated serum IgG4 level.Methods Serum IgG4 samples were collected from the General Hospital of Tianjin Medical University from January 2018 to December 2020.Hp was detected by C^(13) breath test and TB was detected by T-spot(Tuberculosis spot,T-spot)test.The serum IgG4 level was tested by independent sample t test,and the two-sided test(P<0.05)was considered to be statistically significant.Results Among 2139 samples with elevated serum IgG4,33.29%(712/2139)were from patients with IgG4-related disease(IgG4-RD)18.51%(396/2139)were from patients with autoimmune disease(AID),and the rest 48.20%(1031/2139)were classified as other diseases.There was no significant difference in serum IgG4 levels among groups.In IgG4-RD group,gallbladder was the most involved organ,autoimmune pancreatitis was the most common in AID and digestive system diseases were the most common in other diseases.The sensitivity and specificity of international standard(IgG4>1.35 g/L)were 81.00%and 82.48%respectively.The best cut-off value of our data was 1.23 g/L,and the sensitivity and specificity were 84.19%and 80.62%respectively.There was no difference in serum IgG4 level between Hp or TB infected patients and non-infected patients.Conclusions Among all the samples with elevated IgG4,IgG4-RD is the most common,but a variety of AIDs and digestive system diseases can also lead to elevated serum IgG4.We concluded that the cut-off value of IgG4 is 1.23 g/L,which is different from the international recommended 1.35 g/L,which may cause missed diagnosis of patients in gray zone.The data of this study do not support that Hp and TB infection can lead to increased

关 键 词：免疫球蛋白G4 疾病分布 CUT-OFF 诊断效能 幽门螺杆菌 结核 

分 类 号：R593.2[医药卫生—内科学]