上海交通大学学报(医学版)

• 论著(临床研究) • 上一篇    下一篇

血清IgG4对IgG4相关性疾病的诊断价值及该病的眼部表现

杨慧敏1,王晓栋2,叶霜2,华静3,王琴4,李劲1   

  1. 上海交通大学 医学院附属仁济医院 1.眼科, 2.风湿免疫科, 3.消化内科, 4.肾内科, 上海 200127
  • 出版日期:2015-12-28 发布日期:2016-01-21
  • 通讯作者: 李劲, 电子信箱: lijinmpa@163.com; 王晓栋, 电子信箱: wangxdong@yahoo.com。
  • 作者简介:杨慧敏(1992—), 女, 硕士生; 电子信箱: jxcyyhm16@126.com。
  • 基金资助:

    上海市科委科研计划项目(13ZR1424800)

Value of serum IgG4 for the diagnosis of IgG4-related diseases and the ocular manifestations of IgG4-related disease

YANG Hui-min1, WANG Xiao-dong2, YE Shuang2, HUA Jing3, WANG Qin4, LI Jin1   

  1. 1.Department of Ophthalmology, 2.Department of Rheumatology, 3.Department of Gastroenterology, 4.Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2015-12-28 Published:2016-01-21
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 13ZR1424800

摘要:

目的  评价血清IgG4浓度对IgG4相关性疾病的鉴别诊断价值,并探讨IgG4相关性疾病的眼部表现。方法  收集IgG4相关性疾病患者29例,血清IgG4浓度升高的其他疾病患者161例(其中自身免疫性肝病47例,急性胰腺炎15例,原发性肾小球病及肾功能不全61例,炎症性肠病38例),正常对照190例;以免疫散射比浊法测定血清IgG4和IgG浓度,比较各疾病组患者的检测结果。以所有患者的血清IgG4浓度绘制受试者工作特征(ROC)曲线,评价血清IgG4浓度的诊断价值,并确定其诊断IgG4相关性疾病的最佳临界值。同时对IgG4相关性疾病患者进行眼科检查,评估其眼部表现。结果  IgG4相关性疾病组血清IgG4浓度与原发性肾小球病及肾功能不全组、炎症性肠病组、自身免疫性肝病组、急性胰腺炎组比较,差异有统计学意义(P<0.01)。经ROC曲线分析,当IgG4为2.37 g/L时,Youden指数最大,该诊断界值的敏感度为93.1%,特异度为84.3%,曲线下面积为0.939。29例IgG4相关性疾病患者中,2例有眼眶占位性病变,其余患者眼部表现无特异性。结论  血清IgG4浓度对于诊断IgG4相关性疾病具有较高的敏感度和特异度,但仅能作为诊断IgG4相关性疾病的依据之一,提示IgG4相关性疾病的可能;该病眼部表现无特异性。

关键词: 血清IgG4, 诊断价值, 眼部表现

Abstract:

Objective  To evaluate the value of serum IgG4 level for the differential diagnosis of IgG4-related disease (IgG4-RD) and investigate the ocular manifestations of IgG4-RD. Methods  A total of 29 patients with IgG4-RD, 161 patients with other diseases and elevated serum IgG4 levels (among them, 47 patients with autoimmune liver disease, 15 patients with acute pancreatitis, 61 patients with primary glomerulopathy and renal insufficiency, and 38 patients with inflammatory bowel disease), and 190 normal controls were enrolled. Serum IgG4 and IgG levels were measured by immunonephelometry and results of groups were compared. The receiver operating characteristic (ROC) curve was drawn based on the serum IgG4 levels of patients. The diagnostic value of serum IgG4 level was evaluated and the optimal cutoff value of serum IgG4 level for diagnosing IgG4-RD was determined. Patients with IgG4-RD underwent ophthalmologic tests and their ocular manifestations were evaluated. Results  The differences of serum IgG4 level between IgG4-RD group and primary glomerulopathy and renal insufficiency group, inflammatory bowel disease group, autoimmune liver disease group and acute pancreatitis group were statistically significant (P<0.01). According to the analysis of ROC curve, the Youden index reached the biggest when the IgG4 level was 2.37 g/L. The sensitivity and specificity of this cutoff value for the diagnosis of IgG4-RD were 93.1% and 84.3% and the area under the curve was 0.939. Among 29 patients with IgG4-RD, two of them had orbital occupying lesion and others had no special ocular manifestations. Conclusion  The sensitivity and specificity of serum IgG4 level for the diagnosis of IgG4-RD are high and can be regarded as one of evidences for the diagnosis of IgG4-RD. The serum IgG4 level indicates the possibility of IgG4-RD. Patients with IgG4-RD have no special ocular manifestations.

Key words: serum IgG4, diagnostic value, ocular manifestations