The clinical utility of immunoglobulin G4 in the evaluation of autoimmune pancreatitis and pancreatic adenocarcinoma.
The clinical utility of immunoglobulin G4 in the evaluation of autoimmune pancreatitis and pancreatic adenocarcinoma.
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DOI：
10.1016/j.hpb.2017.09.001
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Allen PJ
中科院分区：
文献类型：
--
作者：
Pak LM;Schattner MA;Balachandran V;D'Angelica MI;DeMatteo RP;Kingham TP;Jarnagin WR;Allen PJ
血清免疫球蛋白- g4 （IgG4）水平升高已被用作区分自身免疫性胰腺炎（AIP）和胰腺导管腺癌（PDAC）的诊断标志物，但其真正用途尚不明确。本研究评估了IgG4在鉴别AIP和PDAC中的临床应用。所有在肝胆胰外科诊所接受血清IgG4测定的患者均被纳入。将患者分为IgG4正常组（<135mg/dL）和IgG4升高组（≥135mg/dL）。最终诊断由手术病理或临床结果决定。评估IgG4诊断AIP的敏感性、特异性、PPV和NPV。1997年至2015年间，298名患者被确诊。85%的患者（254/298）IgG4水平正常，15%（44/298）升高。AIP的总患病率为17%（52/298）。IgG4对AIP的敏感性和特异性分别为67%和96%；然而，PPV仅为80%，其中IgG4升高的患者PDAC发生率为9%。在这项选定的接受IgG4检测的患者中，9%的IgG4升高的患者患有PDAC。过度依赖IgG4作为AIP的诊断可能导致PDAC的误诊和延误治疗。
Elevation in the serum immunoglobulin-G4 (IgG4) level has been used as a diagnostic marker to distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC), but its true utility is ill-defined. This study evaluates the clinical utility of IgG4 in differentiating AIP from PDAC. All patients evaluated in the hepatopancreaticobiliary surgery clinics with measured serum IgG4 were included. Patients were divided into normal IgG4 (<135mg/dL) and elevated IgG4 (≥135mg/dL) groups. The final diagnosis was determined by operative pathology when available or by clinical outcome. The sensitivity, specificity, PPV, and NPV of IgG4 for diagnosing AIP was assessed. Between 1997 and 2015, 298 patients were identified. Normal IgG4 levels were present in 85% of patients (254/298), while 15% (44/298) were elevated. The overall prevalence of AIP was 17% (52/298). The sensitivity and specificity of IgG4 for AIP was 67% and 96%, respectively; however, the PPV was only 80%, including a 9% occurrence of PDAC in patients with an elevated IgG4. In this study of selected patients who underwent IgG4 testing, 9% of elevated IgG4 patients had PDAC. The overreliance on IgG4 as diagnostic for AIP may lead to mis-diagnosis and delayed treatment for PDAC.
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