IgG4联合CA19-9对IgG4相关硬化性胆管炎及胆管癌的诊断价值研究  

Diagnostic value of serum immunoglobulin G4 combined with carbohydrate antigen 19-9 in immunoglobulin G4-related sclerosing cholangitis and cholangiocarcinoma

作　　者：张国忠 张金赫 董培玲 姜菲菲[1] 赵文敏 李睿晴 刘静[3] 刘秀红[1] Zhang Guozhong;Zhang Jinhe;Dong Peiling;Jiang Feifei;Zhao Wenmin;Li Ruiqing;Liu Jing;Liu Xiuhong(Department of Clinical Laboratory,Beijing You'an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院临床检验中心,100069 [2]首都医科大学附属北京佑安医院肝病消化中心,100069 [3]首都医科大学附属北京佑安医院肾透析中心,100069 [4]通辽市传染病医院检验科 [5]天津医科大学护理学院

出　　处：《北京医学》2025年第1期22-26,共5页Beijing Medical Journal

基　　金：北京市丰台区卫生计生委基金(2018-62)。

摘　　要：目的探讨血清免疫球蛋白G4(immunoglobulin G4,IgG4)和糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)对免疫球蛋白G4硬化性胆管炎(IgG4-related sclerosing cholangitis,IgG4-SC)和胆管癌(cholangiocarcinoma,CCA)的诊断价值。方法选取2018年6月至2024年6月首都医科大学附属北京佑安医院同时检测IgG4和CA19-9的患者,收集患者一般资料和临床资料,采用多因素非条件logistic回归方程分析CCA的影响因素,采用ROC曲线评估影响因素对CCA的诊断价值。结果共纳入90例患者,其中男62例、女28例;年龄28~85岁,平均(61.9±13.3)岁。IgG4-SC患者30例,其中男21例、女9例,平均年龄(57.5±12.6)岁;CCA患者60例,其中男41例、女19例,平均年龄(64.1±9.6)岁,CCA患者年龄高于IgG4-SC患者(P<0.01)。与IgG4-SC患者相比,CCA患者CA19-9水平较高[127.5(52.7,630.3)U/ml比38.1(15.5,120.9)U/ml],IgG4水平较低[0.5(0.3,0.8)g/L比6.8(3.8,12.4)g/L],差异有统计学意义(P<0.05)。多因素回归分析结果显示,IgG4越低的患者越容易诊断为CCA(OR=0.121,95%CI:0.035~0.416,P<0.05)。当IgG4的cut-off值为2.56 g/L时,其鉴别诊断IgG4-SC与CCA的灵敏度、特异性和ROC曲线AUC分别为96.7%、93.3%和0.971(95%CI:0.911~0.995,P<0.05);当CA19-9的cut-off值为62.4 U/ml时,其鉴别诊断IgG4-SC与CCA的灵敏度、特异性和ROC曲线AUC分别为73.3%、66.7%和0.724(95%CI:0.620~0.813,P<0.05)。IgG4联合CA19-9鉴别诊断IgG4-SC与CCA的灵敏度为95.0%,特异性为97.0%,ROC曲线AUC为0.987(95%CI:0.936~0.999,P<0.05)。对4例误诊为CCA的IgG4-SC患者进行评估,发现2例患者的IgG4水平为IgG4 cut-off值(2.56 g/L)的2倍,2例患者CA19-9值均低于CA19-9的cut-off值(62.4 U/ml),均不符合CCA诊断。结论血清IgG4和CA19-9可有效鉴别诊断IgG4-SC和CCA,两者联合检测时可提高IgG4-SC和CCA的诊断效能。Objective To explore the diagnostic value of serum immunoglobulin G4(IgG4)and cholangiocarcinoma 19-9(CA19-9)for IgG4-related sclerosing cholangitis(IgG4-SC)and cholangiocarcinoma(CCA).Methods Patients who were simultaneously tested for IgG4 and CA 19-9 in Beijing You'an Hospital affiliated to Capital Medical University from June 2018 to June 2024 were selected,and their general and clinical data were collected.Multivariate unconditional logistic regression equation was used to analyze the influencing factors of CCA,and the diagnostic value of influencing factors for CCA was evaluated by ROC curve.Results A total of 90 patients were selected,including 62 males and 28 females,aged from 28 to 85 years,with an average age of(61.9±13.3)years.There were 30 patients with IgG4-SC,including 21 males and nine females with an average age of(57.5±12.6)years,while there were 60 patients with CCA,including 41 males and 19 females with an average age of(64.1±9.6)years.The age of CCA patients was higher than that of IgG4-SC patients(P<0.01).Compared with IgG4-SC patients,the level of CA 19-9 in CCA patients was higher[127.5(52.7,630.3)U/ml vs.38.1(15.5,120.9)U/ml],and the level of IgG4 was lower[0.5(0.3,0.8)g/L vs.6.8(3.8,12.4)g/L],and the differences were statistically significant(P<0.05).Multivariate regression analysis results showed that patients with lower IgG4 were more likely to be diagnosed as CCA(OR=0.121,95%CI:0.035-0.416,P<0.05).When the cut-off value of IgG4 was 2.56 g/L,its sensitivity,specificity and AUC of ROC curve for differential diagnosis of IgG4-SC and CCA were 96.7%,93.3%and 0.971(95%CI:0.911-0.995,P<0.05),respectively.When the cut-off of CA19-9 was 62.4 U/ml,its sensitivity,specificity and AUC of ROC curve for differential diagnosis of IgG4-SC and CCA were 73.3%,66.7%and 0.724(95%CI:0.620-0.813,P<0.05),respectively.The sensitivity and specificity of IgG4 combined with CA19-9 in differential diagnosis of IgG4-SC and CCA were 95.0%and 97.0%,and the AUC of ROC curve was 0.987(95%CI:0.936-0.999,P<0.05).Four

关 键 词：IgG4相关硬化性胆管炎 胆管癌 免疫球蛋白G4 糖类抗原19-9 

分 类 号：R575.7[医药卫生—消化系统] R735.8[医药卫生—内科学]