血清IgG4、IgG4/IgG等血清学指标在IgG4相关性疾病中的研究

陈思宇

摘要：目的：探討免疫球蛋白G4（IgG4）、IgG4/免疫球蛋白G（IgG）等血清学指标在IgG4相关性疾病（IgG4-RD）中的研究。方法：采用回顾性分析方法，选取2019年6月至2020年6月一年间我院收治的13例IgG4-RD患者（观察组）及同期于我院接受诊疗的52例其他自身免疫性疾病患者（对照组）和常规体检的59例健康者（健康组）作为研究对象，三组均应用免疫散射比浊法检测其IgG4、IgG等血清学指标水平，并计算IgG4与IgG的比值，详细统计数据并加以对比;观察组经治疗出院后实施1年随访观察，检测其血清IgG4及IgG4/IgG等血清学指标水平变化情况。结果：观察组IgG、IgE、IgG4、IgG4/IgG等血清学指标水平均相较对照组、健康组明显升高（P<0.05）;对照组IgG、IgG4、IgG4/IgG等血清学指标水平相较健康组无明显差异（P>0.05）;对照组IgE指标水平相较健康组明显升高（P<0.05）;随访过程中发现，观察组经治疗后血清IgG水平相较治疗前明显降低（P<0.05）。结论：将血清IgG指标用于IgG4-RD患者的诊断中具有较高敏感性，IgG指标水平上升可以有效诊断IgG4-RD，并评价其疗效，有效性和应用价值较高，值得推广。

关键词：免疫球蛋白;IgG4相关性疾病;血清学指标;自身免疫性疾病

【Abstract】Objective： To investigate the research of immunoglobulin G4 （IgG4）， IgG4/immunoglobulin G （IgG） and other serological indicators in IgG4-related diseases （IgG4-RD）. Methods： Select 13 IgG4-RD patients （observation group） admitted to our hospital from June 2019 to June 2020 and 52 patients with other autoimmune diseases （control group） and routine treatments in our hospital during the same period. The 59 healthy subjects （healthy group） undergoing physical examination are the research objects. All three groups need to use immunoscattering turbidimetry to detect their IgG， IgG4 and other serological indicators. At the same time， the ratio of IgG4 to IgG needs to be calculated， and detailed statistics are added. Contrast; the observation group was followed up for 1 year after being discharged from the hospital， and the changes in serum IgG4 and IgG4/IgG and other serological indicators were detected. Results： The levels of IgG， IgE， IgG4， IgG4/IgG and other serological indexes in the observation group were significantly higher than those in the control group and healthy group （P<0.05）; the levels of IgG， IgG4， IgG4/IgG and other serological indexes in the control group were similar There was no significant difference from the healthy group （P>0.05）; the IgE index level of the control group was significantly higher than that of the healthy group （P<0.05）; during the follow-up process， it was found that the serum IgG level of the observation group was significantly lower after treatment than before treatment （ P<0.05）. Conclusion： The use of serum IgG indicators in the diagnosis of patients with IgG4-RD has high sensitivity. Increased levels of IgG indicators can effectively diagnose IgG4-RD and evaluate its efficacy. The effectiveness and application value are high， and it is worthy of promotion.

[Keywords] immunoglobulin; IgG4-related diseases; serological indicators; autoimmune diseases

【中图分类号】R781.6+2 【文献标识码】A 【文章编号】1673-9026（2021）08-035-02

IgG4相关性疾病（IgG4 related disease，IgG4-RD）的发现可以追溯到1995年日本学者Yosida等针对自身免疫性胰腺炎（autoimmune pancreatitis，AIP）的研究中，研究中发现AIP的发生机制与自身免疫状况存在密切相关，2001年，临床研究发现IgG4阳性浆细胞与AIP存在一定的联系，AIP患者发病后常合并器官、组织感染，例如胆管、腹膜后组织以及唾液腺等，在對这些合并感染标本实施活检检测，检测结果均存在IgG4阳性淋巴细胞浆细胞浸润这一现象。2003年Kamisawa等学者首次提出来IgG4相关性疾病这一概念[1-2]。IgG4-RD则于20世纪末逐步被国际医学界所认可，并于2010年将其正式命名为免疫性疾病[3]。IgG4-RD在中老年男性群体中高发，属于与IgG4存在密切关联的自身免疫性疾病，患病后会累及淋巴结、胆管、肺、肾、胆囊以及一线等多个组织器官，相关性疾病则主要包括间质性肺炎、下垂体炎、良性淋巴上皮病、前列腺炎以及AIP等，其中以AIP、良性淋巴上皮病最为常见。……