血清IgG4在不同疾病患者中的表达

目的：探讨血清IgG4在不同疾病患者中的表达，以及其在IgG4相关性疾病患者治疗前后的变化和临床意义。方法：选择北京大学人民医院2015年1月1日至2016年3月31日就诊患者中进行血清IgG4检验的620例患者为研究对象进行回顾性分析，按照病种的不同分为普通疾病组、自身免疫性疾病组及IgG4相关性疾病组；胰腺疾病患者分为自身免疫性胰腺炎组及胰腺癌组；按照疾病治疗阶段不同将IgG4相关性疾病患者再分为治疗前组及治疗后组；分别分析对比各组患者血清IgG4的表达。结果：普通疾病组的患者血清IgG4水平中位数为0.480（0.005，50.400） g/L ，自身免疫性疾病组患者血清IgG4水平中位数为0.406（0.003，18.700） g/L，IgG4相关性疾病组患者血清IgG4水平中位数为5.200（0.046，46.000）g/L，明显高于普通疾病组及自身免疫性疾病组，与该两组患者血清IgG4水平差异有统计学意义（P<0.01），普通疾病组与自身免疫性疾病组患者血清IgG4水平相比，差异无统计学意义（P>0.05）。胰腺疾病患者中，自身免疫性胰腺炎组患者血清IgG4水平中位数为3.735（0.063，46000） g/L，胰腺癌组患者血清IgG4水平中位数为0.438（0.056，1.130） g/L，自身免疫性胰腺炎组患者血清IgG4水平高于胰腺癌组，差异具有统计学意义（P<0.01）。在IgG4相关性疾病患者中，治疗前患者组血清IgG4水平中位数为6.540（1.330，34.100） g/L，治疗后患者组血清IgG4水平中位数为3.705（0.208，30.200） g/L，血清IgG4水平在患者治疗后下降，低于治疗前水平，差异具有统计学意义（P<0.01）。结论：不同疾病类型的患者血清IgG4表达不同，在自身免疫性胰腺炎及IgG4相关性疾病中，患者血清IgG4表达明显升高，通过检测患者血清IgG4水平的高低，可以为不同疾病的鉴别诊断提供依据；在IgG4相关性疾病中，血清IgG4水平在治疗后表达明显下降，血清IgG4有可能作为评估IgG4相关性疾病疗效的指标之一。

Expression of serum IgG4 in patients with different diseases

Objective:To investigate serum IgG4 levels in different diseases and the changes of serum IgG4 levels in post treatment of IgG4 related disease.Methods:Clinical data of 620 patients who received investigation of serum IgG4 in Peking University People's Hospital from January 1,2015 to March 31,2016 were collected retrospectively.According to the difference of the diseases,they were divided into common group of diseases,autoimmune diseases and IgG4 related diseases;pancreatic disease patients were divided into autoimmune pancreatitis and pancreatic cancer group;According to different treatment stages of the disease,the patients with IgG4 related diseases were divided into pretreatment group and post treatment group.And the expressions of the patients' serum IgG4 levels in different groups were analyzed.Results:The median serum IgG4 level in the group of the patients with common diseases was 0.480 (0.005,50.400) g/L,in the group of autoimmune disease was 0.406 (0.003,18.700) g/L,in the group of IgG4 related diseases was 5.200(0.046,46.000) g/L,which was significantly higher in the group of IgG4 related diseases than the other two groups,and there was obvious statistical significance in serum IgG4 levels between the group of IgG4 related diseases and the other two groups (P ＜0.01);There was no obvious difference in serum IgG4 levels between the common disease group and the autoimmune disease group,and there was no obvious statistical difference in serum IgG4 levels between the two groups (P ＞ 0.05).In the patients with IgG4 related diseases,the median serum IgG4 level in the group of pretreatment patients was 6.540 (1.330,34.100) g/L,and 3.735 (0.063,46.000) g/L in the post treatment patients.Serum IgG4 levels decreased in post treatment group,significantly lower than in pretreatment,there was obvious statistical difference in serum IgG4 levels between the two groups (P ＜ 0.01).The median serum IgG4 level in the group of patients with autoimmune pancreatitis was 3.735 (0.063,46.000) g/L,and 0.438 (0.056,1.130) g/L in the group of patients with pancreatic cancer,which was significantly higher in the group of patients with autoimmune pancreatitis than the others,and there was obvious statistical difference in serum IgG4 levels between the two groups (P ＜0.01).Conclusion:Serum IgG4 levels in patients with different diseases were different,and were significantly higher in patients with autoimmune pancreatitis and IgG4 related diseases,so serum IgG4 levels can provide the basis for the differential diagnosis of different diseases;Serum IgG4 levels in patients with IgG4 related diseases decrease significantly after treatment,so it can be used as an important index to evaluate the curative effect of IgG4 related diseases.