血清IgG4检测在IgG4-RD诊治和转归中的应用研究  

Application of serum IgG4 detection in diagnosis,treatment and prognosis of IgG4-RD

作　　者：杨艳艳 李赛男 夏雨鑫 姜玉章[2] YANG Yanyan;LI Sainan;XIA Yuxin;JIANG Yuzhang(Department of Medical Laboratory,Jiangsu Sihong Fen Jinting Hospital,Sihong 223900,China;Department of Clinical Laboratory,the First Huaian Hospital Affili-ated to Nanjing Medical University,Huaian 223300,China)

机构地区：[1]江苏泗洪分金亭医院检验科,泗洪223900 [2]南京医科大学附属淮安第一医院检验科,淮安223300

出　　处：《中国免疫学杂志》2025年第4期948-953,共6页Chinese Journal of Immunology

基　　金：淮安市医学检验重点实验室(HAP202004)。

摘　　要：目的:探讨血清IgG4检测在IgG4相关性疾病(IgG4-RD)诊治、病情评估及转归中的价值。方法:综合患者的临床资料,回顾性系统分析2013年3月至2023年10月在南京医科大学附属淮安第一医院就诊且诊断为IgG4-RD的26例患者常见实验室检查、影像学检查、病理学检查等结果。结果:26例患者中位发病年龄65(31~90)岁,男女比例为3.33∶1。首发症状前三位为腹部不适、皮肤巩膜黄染和发热。患者主要为多器官受累,最常累及的器官为肺、胰腺、肝、肾、胆管。与对照组比较,患者首次血液学、生化及免疫检测结果显示NLR、PLR、ESR、CRP、TBIL、DBIL、ALT、AST、GGT、IgG、IgA、IgM均异常升高,差异有统计学意义(P<0.05),C3、C4均下降,但差异无统计学意义(P>0.05)。IgG4-RD患者首次IgG4水平与住院时长、复诊时长,再次复诊IgG4水平的动态变化有一定的关系。结论:血清IgG4检测对IgG4-RD诊治发挥重要作用。IgG4异常高水平患者,针对大剂量糖皮质激素治疗敏感的人,IgG4水平下降较快,症状缓解时间较长。Objective:To investigate the value of serum IgG4 detection in diagnosis,treatment,evaluation and outcome of IgG4-associated diseases(IgG4-RD).Methods:By integrating the clinical data of patients,retrospectively and systematically analyze the results of common laboratory examinations,imaging examinations,pathological examinations,etc.26 patients who were diagnosed with IgG4-RD in Huaian First Hospital Affiliated to Nanjing Medical University from March 2013 to October 2023.Results:The median age of onset was 65(31~90)years old,and the male to female ratio was 3.33∶1.The first three symptoms were abdominal discomfort,skin scleral yellow stain and fever.Patients mainly involved multiple organs,the most commonly involved organs were lung,pancreas,liver,kidney,bile duct.Compared with the control group,NLR,PLR,ESR,CRP,TBIL,DBIL,ALT,AST,GGT,IgG,IgA and IgM were all abnormally elevated in the first hematological,biochemical and immune tests of the patients,the difference was statistically significant,while C3 and C4 were all decreased,but there was no statistical difference.The first IgG4 level of IgG4-RD patients was correlated with the length of hospitalization,the length of return visit,and the dynamic changes of IgG4 level after return visit.Conclusion:Serum IgG4 detection plays an important role in the diagnosis and treatment of IgG4-RD.In patients with abnormally high level of IgG4,those who are sensitive to high-dose glucocorticoid therapy have a faster decline in IgG4 levels and a longer duration of symptom remission.

关 键 词：IgG相关性疾病(IgG4-RD) 免疫球蛋白G亚型 血清 

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