Clinical strategies for differentiating IgG4-related cholecystitis from gallbladder carcinoma to avoid unnecessary surgical resection
Clinical strategies for differentiating IgG4-related cholecystitis from gallbladder carcinoma to avoid unnecessary surgical resection
复制标题
区分 IgG4 相关胆囊炎和胆囊癌的临床策略，以避免不必要的手术切除
DOI：
10.1007/s11427-019-9539-6
复制
发表时间：
2020-05-01
影响因子：
9.1
通讯作者：
Liu，Chao
中科院分区：
文献类型：
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作者：
Zhang，Rui;Lin，Hao-Ming;Liu，Chao
免疫球蛋白G4 （IgG4）相关性胆囊炎（IgG4- c）通常难以与胆囊癌（GBC）区分。本研究旨在确定区分IgG4-C和GBC的实用策略，以避免不必要的手术切除。免疫组化法检测IgG4在胆囊组织中的表达。回顾性分析IgG4-C患者与GBC患者的临床病理及影像学特征。免疫组化结果显示IgG4在IgG4- c组织浆细胞中表达上调。IgG4-C患者血清总胆红素水平中位数显著高于GBC患者（45.8µmol L−1vs）。29.9µmol L−1)。IgG4-C患者血清γ-GGT水平高于GBC患者，而GBC患者血清CA125水平明显高于IgG4-C患者。基于胆囊壁的分层模式和Rokitansky-Aschoff窦的存在，成像扫描有助于区分IgG4-C和GBC。两组患者在年龄、腹痛、消瘦程度等方面均无统计学差异。我们的研究表明，影像与血清总胆红素、γ-GGT和CA125水平的结合可以增加术前诊断价值，降低IgG4-C的误诊率。
Immunoglobulin G4 (IgG4)-related cholecystitis (IgG4-C) is often difficult to distinguish from gallbladder carcinoma (GBC). This study aimed to determine a practical strategy for differentiating between IgG4-C and GBC to avoid unnecessary surgical resection. The expression of IgG4 in the gallbladder was detected by immunohistochemistry. The clinicopathological and radiological characteristics of IgG4-C patients and GBC patients were analyzed retrospectively. Immunohistochemistry revealed that IgG4 was upregulated in the plasma cells of IgG4-C tissues. The median serum total bilirubin levels were significantly higher in the patients with IgG4-C than in those with GBC (45.8 µmol L−1vs. 29.9 µmol L−1). The serum γ-GGT levels were higher in IgG4-C patients than in GBC patients, whereas the serum levels of CA125 were significantly higher in GBC patients than in IgG4-C patients. The imaging scans were helpful for differentiating IgG4-C from GBC based on the presence of a layered pattern and Rokitansky-Aschoff sinuses in the gallbladder wall. There were no statistically significant differences in age, presence of abdominal pain, level of emaciation between the two groups. Our study demonstrated that the combination of imaging with serum total bilirubin, γ-GGT and CA125 levels can offer added preoperative diagnostic value and reduce the rate of IgG4-C misdiagnosis.