自身免疫性肝病患者血清IgG4水平分析

探讨不同自身免疫性肝病患者血清免疫球蛋白G4（immunoglobulin G4，IgG4）水平差异，并分析不同血清IgG4水平的自身免疫性肝病患者临床特点的差异。方法收集自身免疫性肝病患者65例，其中自身免疫性肝炎（AIH）11例、原发性胆汁性肝硬化（primary biliary cirrhosis，PBC）47例及AIH与PBC重叠综合征7例。采用免疫散射比浊法检测三组患者血清IgG4水平，并分析三组之间血清IgG4水平的差异。根据血清IgG4水平的不同进行分组，分析不同血清IgG4水平的自身免疫性肝病患者临床特点的差异。对组间正态分布的计量资料的比较应用独立样本t检验，对非正态分布者采用Mann-Whitney U检验。计数资料的比较采用Fisher’s确切概率法。结果 AIH患者血清 IgG4水平为642.2 mg/L （97.7 mg/L~1687.0 mg/L），高于 PBC 患者[153.9 mg/L（78.9 mg/L~400.3 mg/L），P=0.076]及重叠综合征患者[229.9 mg/L（154.9 mg/L~417.9 mg/L），P=0.388]，无统计学差异。其中3例AIH患者血清IgG4水平异常升高（≥1350 mg/L），与血清IgG4水平较低的8例AIH患者比，IgG4水平和IgG4/IgG比值较高，差异具有统计学意义（P〈0.05）；3例血清IgG4水平≥1350 mg/L的AIH患者均合并2型糖尿病，其中1例合并类风湿性关节炎，而其他8例AIH患者未合并其他自身免疫性或代谢性疾病；血清IgG4水平较高（IgG4水平≥200 mg/L）的14例PBC患者与IgG4水平较低的33例PBC患者比，血清总胆红素水平较高[（45.09±74.85）μmol/L 对（26.38±23.03）μmol/L，P=0.05]。结论与PBC及PBC与AIH 重叠综合征患者比，AIH患者血清IgG4水平较高。血清IgG4水平较高的AIH患者可能较易合并其他自身免疫性或代谢性疾病。

Serum IgG4 levels in patients with autoimmune liver diseases

To study the differences of serum IgG4 levels in various autoimmune liver diseases and to analyze the clinical characterization of patients with high serum IgG4 levels. Methods 65 patients with autoimmune liver diseases were enrolled for this study including 11 patients with autoimmune hepatitis （AIH）,47 patients with primary biliary cirrhosis （PBC） and 7 patients with overlap syndrome of AIH and PBC. The serum IgG4 levels was detected by immuno-scatter turbidmetry. The differences of serum IgG4 levels in the three groups were studied. The clinical features of patients with autoimmune liver disease were analyzed according to their serum IgG4 levels. The significance of inter-group differences of measurement data was assessed by Student’s t-test or Mann-Whitney U test and enumeration data by Fisher’s exact test. Results The serum IgG4 levels in patients with AIH was 642.2 mg/L（97.7 mg/L~1687.0 mg/L）,a little higher than in patients with PBC [153.9 mg/L（78.9 mg/L~400.3 mg/L）,P=0.076] and in with overlap syndrome [229.9 mg/L（154.9 mg/L ~417.9 mg/L）,P=0.388];Three patients with AIH had high serum IgG4 levels （≥1350 mg/L） out of 11 patients with AIH. The ratio of IgG4/IgG was higher in the three patients with higher as compared to 8 with relatively low serum IgG4 levels （P﹤0.05）;The three patients with elevated IgG4 levels had diabetes mellitus type 2 and one of them was also complicated with rheumatoid arthritis,whereas the other 8 patients with low serum IgG4 levels were not;14 patients with PBC with higher serum IgG4 levels （≥200 mg/L） had higher total serum bilirubin levels as com-pared to those in 33 patients with relatively low serum IgG4 levels [（45.09 ±74.85）μmol/L vs.（26.38 ±23.03）μmol/L,P=0.05）]. Conclusion Compared with patients with PBC or overlap syndrome of AIH and PBC,the pa-tients with AIH have a higher serum IgG4 levels. The patients with AIH with high serum IgG4 levels might be complicated with other autoimmune or metabolic diseases.