Clinical and biochemical characteristics of patients having general symptoms with increased serum IgG4
Clinical and biochemical characteristics of patients having general symptoms with increased serum IgG4
复制标题
DOI：
10.1080/14397595.2019.1642291
复制
发表时间：
2019-07-31
影响因子：
2.2
通讯作者：
Otsuka，Fumio
中科院分区：
文献类型：
--
作者：
Hasegawa，Kou;Hanayama，Yoshihisa;Otsuka，Fumio
目的：区分就诊于全科的 IgG4 相关疾病（RD）患者与其他高 IgG4 病症的患者。方法：根据最终诊断将 56 例血清 IgG4 水平高（>135 mg/dL）的患者分为三组：明确的和可能的 IgG4-RD 组和其他组。回顾性分析三组患者的临床和实验室特征。结果：主要表现为肾功能障碍和全身不适，其中口渴是确诊组最常见的症状，其中颌下腺和淋巴结可能受到影响。尽管活检频率很高，但小唾液腺活检对 IgG4-RD 的诊断效果最少。明确组血清IgG4和IgG、IgG4/IgG比值和嗜碱性粒细胞数升高，血清CRP、IgA和补体水平降低。明确组血清IgG4与IgM水平呈负相关。结论：结果提示，肾功能不全、不适、口渴或体重减轻的患者，检测嗜碱性粒细胞、免疫球蛋白和补体水平有助于诊断IgG4-RD。考虑到受影响组织的分布和诊断性活检的定位，早期诊断需要进行体格检查和实验室检查。
Objective:To differentiate patients with IgG4-related diseases (RD) from patients with other hyper IgG4 conditions who visit general medicine department.Methods:Fifty-six patients with high serum IgG4 levels (>135 mg/dL) were classified into three groups based on the final diagnosis: definite and possible IgG4-RD and others. Clinical and laboratory characteristics of the three groups of patients were retrospectively analyzed.Results:Major manifestations were renal dysfunction and general malaise, while thirst was the most frequent symptom in the definite group, in which submandibular glands and lymph nodes were likely to be affected. Biopsy of minor salivary glands was the least diagnostic for IgG4-RD despite the high frequency of biopsy. In the definite group, serum levels of IgG4 and IgG, IgG4/IgG ratio and basophil number were increased, while serum levels of CRP, IgA and complements were decreased. A negative correlation between serum levels of IgG4 and IgM was found in the definite group.Conclusion:The results indicated that in patients with renal dysfunction, malaise, thirst or weight loss, measurements of the levels of basophils, immunoglobulins and complements are helpful for diagnosing IgG4-RD. Considering distribution of affected tissues and localization of diagnostic biopsies, physical examination and laboratory workup are required for early diagnosis.