Clinical features of IgG4-related dacryoadenitis
Clinical features of IgG4-related dacryoadenitis
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DOI：
10.1007/s00417-013-2541-y
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发表时间：
2014-03-01
影响因子：
2.7
通讯作者：
Ozaki, Noriko
中科院分区：
文献类型：
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作者：
Koizumi, Satomi;Kamisawa, Terumi;Ozaki, Noriko
为了阐明IgG 4相关性泪腺炎的临床特征，前瞻性研究了12例患者的临床特征、实验室检查、放射学检查、相关疾病、治疗和预后（七男五女;平均年龄60.9 ± 15.1岁），与IgG 4相关的泪腺炎。除了眼睑肿胀，在7名患者中观察到其他眼科症状，包括复视（n = 4）、上睑下垂（n = 2）、视野障碍（n = 2）、眼痛（n = 2）、视力下降（n = 2）、眼球运动障碍（n = 1）、干眼症（n = 1）、角膜溃疡（n = 1）和溢泪（n = 1）。一半患者的泪腺肿胀是双侧的。9例患者中存在其他IgG 4相关疾病，包括涎腺炎（n = 5）、自身免疫性胰腺炎（n = 4）、腹膜后纤维化（n = 2）和淋巴结病（n = 8）。其他IgG 4相关疾病患者的血清IgG 4水平（1070 +/- 813 mg/dl）显著高于无疾病患者（197 +/- 59 mg/dl，p = 0.017）。过敏史和血清IgE水平升高，分别检测到6例患者。8例患者显示炎性延伸超出泪腺，如直肌增厚（n = 6），视神经炎症（n = 2）和球后炎症（n = 3）。7例患者激素治疗有效，但2例患者复发，血清IgG 4水平明显升高，并伴有自身免疫性胰腺炎。IgG 4相关性泪腺炎表现为泪腺以外广泛的炎症，常与其他IgG 4相关性疾病或过敏现象相关，以及激素反应性。
To elucidate the clinical characteristics of IgG4-related dacryoadenitis.Clinical features, laboratory findings, radiological findings, associated diseases, treatment, and prognosis were prospectively examined in 12 patients (seven men, five women; mean age, 60.9 +/- 15.1 years) with IgG4-related dacryoadenitis.In addition to eyelid swelling, other ophthalmologic symptoms were observed in seven patients, including diplopia (n = 4), ptosis (n = 2), visual field disturbance (n = 2), eye pain (n = 2), decrease of visual acuity (n = 2), eye-movement disturbance (n = 1), dry eye (n = 1), corneal ulcer (n = 1), and epiphora (n = 1). Swelling of the lacrimal glands was bilateral in half of the patients. Other IgG4-related diseases were present in nine patients, including sialadenitis (n = 5), autoimmune pancreatitis (n = 4), retroperitoneal fibrosis (n = 2), and lymphadenopathy (n = 8). Serum IgG4 levels were significantly higher in patients with other IgG4-related disease (1070 +/- 813 mg/dl) than in those without (197 +/- 59 mg/dl, p = 0.017). Allergic histories and elevated serum IgE levels were each detected in six patients. Eight patients showed inflammatory extension beyond the lacrimal gland, such as thickened rectus muscle (n = 6), inflammation of the optic nerve (n = 2), and retrobulbar inflammation (n = 3). Steroid therapy was effective in seven patients, but dacryoadenitis relapsed in two patients with markedly higher serum IgG4 levels and autoimmune pancreatitis.IgG4-related dacryoadenitis showed various ophthalmologic symptoms due to extensive inflammation beyond the lacrimal gland, frequent association with other IgG4-related disease or allergic phenomena, and steroid responsiveness.