不同血清IgG4临界值对IgG4相关性疾病的诊断效能  

Diagnostic efficacy of different serum IgG4 thresholds for IgG4-related diseases

作　　者：嵇金陵 姜玉章[1] 韩崇旭[2] 王丽[3] 靳德甫 叶耘峰 刘家秀 JI Jinling;JIANG Yuzhang;HAN Chongxu;WANG Li;JIN Defu;YE Yunfeng;LIU Jiaxiu(Department of Clinical Laboratory,the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Huaian 223300,Jiangsu,China;Department of Clinical Laboratory,Northern Jiangsu People's Hospital,Yangzhou 225001,Jiangsu,China;Department of Clinical Laboratory,Xuzhou First People's Hospital,Xuzhou 221001,Jiangsu,China;Jiangsu College of Nursing,Huaian 223003,Jiangsu,China)

机构地区：[1]南京医科大学附属淮安第一医院检验科,江苏淮安223300 [2]苏北人民医院检验科,江苏扬州225001 [3]徐州市第一人民医院检验科,江苏徐州221001 [4]江苏护理职业学院,江苏淮安223003

出　　处：《检验医学》2024年第8期733-737,共5页Laboratory Medicine

基　　金：淮安市创新服务能力建设计划-重点实验室建设项目(HAP202004)。

摘　　要：目的探讨不同血清IgG4临界值对IgG4相关性疾病(IgG4-RD)的诊断效能。方法选取2013年1月—2021年7月南京医科大学附属淮安第一医院、苏北人民医院和徐州市第一人民医院首次接受血清IgG4检测的患者5059例,其中IgG4-RD患者38例(IgG4-RD组)、非IgG4-RD患者5021例(非IgG4-RD组);以南京医科大学附属淮安第一医院131名健康体检者作为正常对照组。采用免疫散射比浊法检测血清IgG4水平。采用受试者工作特征(ROC)曲线评价IgG4鉴别诊断IgG4-RD的效能。分析不同IgG4临界值鉴别诊断IgG4-RD的效能。结果38例IgG4-RD患者中,有35例(92.1%)IgG4>1.35 g·L^(-1),34例(89.5%)IgG4>2.01 g·L^(-1);有23例(60.5%)患者多器官受累。5021例非IgG4-RD患者中,有430例(8.6%)血清IgG4>1.35 g·L^(-1),203例(4.0%)血清IgG4>2.01 g·L^(-1)。正常对照组、非IgG4-RD组和IgG4-RD组血清IgG4水平依次升高(P<0.001)。以1.59 g·L^(-1)为临界值,IgG4鉴别诊断IgG4-RD的曲线下面积(AUC)为0.971,敏感性为92%,特异性为94%。以1.35、1.40、2.01、2.80 g·L^(-1)为临界值,IgG4鉴别诊断IgG4-RD的敏感性和特异性分别为92%和91%、92%和92%、89%和96%、79%和97%。结论IgG4水平升高不仅见于IgG4-RD,还常见于非IgG4-RD。临床应根据不同诊治需求,基于相应的IgG4临界值来辅助诊断IgG4-RD。Objective To investigate the diagnostic efficacy of different serum IgG4 thresholds for IgG4-related diseases(IgG4-RD).Methods From January 2013 to July 2021,5059 patients who received serum IgG4 determination for the first time in the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Northern Jiangsu People's Hospital and Xuzhou First People's Hospital were enrolled.There were 38 patients with IgG4-RD(IgG4-RD group)and 5021 patients without IgG4-RD(non-IgG4-RD group).Totally,131 healthy subjects from the First Affiliated Hospital of Huaian,Nanjing Medical University were enrolled as healthy control group.Serum IgG4 levels were determined by immunoscattering turbidimetry.Receiver operating characteristic(ROC)curve was used to evaluate the differential diagnosis of IgG4-RD by IgG4.The differential diagnosis of IgG4-RD with different IgG4 thresholds was analyzed.Results Among 38 patients with IgG4-RD,35(92.1%)cases had IgG4>1.35 g·L^(-1),and 34(89.5%)cases had IgG4>2.01 g·L^(-1).Multiple organs were involved in 23(60.5%)cases.Of the 5021 non-IgG4-RD patients,430(8.6%)cases had serum IgG4>1.35 g·L^(-1),and 203(4.0%)cases had serum IgG4>2.01 g·L^(-1).Serum IgG4 levels were increased successively among healthy control group,non-IgG4-RD group and IgG4-RD group(P<0.001).The area under curve(AUC)for the differential diagnosis of IgG4-RD was 0.971,the optimal threshold was 1.59 g·L^(-1),the sensitivity was 92%,and the specificity was 94%.In the differential diagnosis of IgG4-RD,the sensitivity and specificity were 92%and 91%when the threshold of IgG4 was 1.35 g·L^(-1),and they were 92%and 92%when the threshold was 1.40 g·L^(-1),respectively.When the threshold was 2.01 g·L^(-1),the sensitivity and specificity were 89%and 96%,and when the threshold was 2.80 g·L^(-1),the sensitivity and specificity were 79%and 97%,respectively.Conclusions Increased levels of IgG4 are seen not only in IgG4-RD patients,but also in non-IgG4-RD patients.Appropriate IgG4 thresholds should be established to assist cli

关 键 词：IGG4 临界值 IGG4相关性疾病 自身免疫性疾病 

分 类 号：R446.1[医药卫生—诊断学]