Value of serum IgG4 in the diagnosis of IgG4-related disease and in differentiation from rheumatic diseases and other diseases
Value of serum IgG4 in the diagnosis of IgG4-related disease and in differentiation from rheumatic diseases and other diseases
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DOI：
10.1007/s10165-011-0532-6
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发表时间：
2012-06-01
影响因子：
2.2
通讯作者：
Shinomura, Yasuhisa
中科院分区：
文献类型：
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作者：
Yamamoto, Motohisa;Tabeya, Tetsuya;Shinomura, Yasuhisa
IgG 4相关疾病（IgG 4-RD）是一种新的疾病实体，包括Mikulicz病，自身免疫性胰腺炎（AIP）和许多其他疾病。其特征在于血清IgG 4水平升高和受累器官中大量携带IgG 4的浆细胞浸润。我们假设高水平的血清IgG 4将构成一个有用的诊断工具，但关于IgG 4在其他条件比IgG 4-RD，包括风湿性疾病的信息很少。一些报告描述了诊断IgG 4-RD时血清IgG 4的临界值，但这些研究大多使用AIP中135 mg/dL来区分胰腺癌，而不是风湿性和其他常见疾病。没有证据表明风湿性疾病和常见疾病（通常合并风湿性疾病）的血清IgG 4水平临界值为135 mg/dL。这项工作的目的是重新评估AIP中的常用血清IgG 4临界值（135 mg/dL），该临界值用于通过测量IgG 4-RD和各种疾病中的血清IgG 4水平来诊断风湿病诊所中的全IgG 4-RD。因此，我们构建了418例因IgG 4-RD和各种风湿性疾病和常见疾病而就诊于札幌医科大学医院的患者血清IgG 4水平的ROC曲线。诊断IgG 4-RD的最佳临界值为144 mg/dL，敏感性和特异性分别为95.10%和90.76%。在IgG 4-RD、Churg-Strauss综合征、多中心Castleman病、嗜酸性粒细胞性疾病以及某些类风湿性关节炎、系统性硬化症、慢性肝炎和肝硬化患者中，血清IgG 4水平升高。AIP中135 mg/dL的通常截止值可用于诊断完整的IgG 4-RD，但有时不仅在IgG 4-RD中观察到高水平的血清IgG 4，而且在其他风湿性疾病和常见疾病中也观察到高水平的血清IgG 4。
IgG4-related disease (IgG4-RD) is a novel disease entity that includes Mikulicz's disease, autoimmune pancreatitis (AIP), and many other conditions. It is characterized by elevated serum IgG4 levels and abundant IgG4-bearing plasmacyte infiltration of involved organs. We postulated that high levels of serum IgG4 would comprise a useful diagnostic tool, but little information is available about IgG4 in conditions other than IgG4-RD, including rheumatic diseases. Several reports have described cutoff values for serum IgG4 when diagnosing IgG4-RD, but these studies mostly used 135 mg/dL in AIP to differentiate from pancreatic cancer instead of rheumatic and other common diseases. There is no evidence for a cutoff serum IgG4 level of 135 mg/dL for rheumatic diseases and common diseases that are often complicated with rheumatic diseases. The aim of this work was to re-evaluate the usual cutoff serum IgG4 value in AIP (135 mg/dL) that is used to diagnose whole IgG4-RD in the setting of a rheumatic clinic by measuring serum IgG4 levels in IgG4-RD and various disorders. We therefore constructed ROC curves of serum IgG4 levels in 418 patients who attended Sapporo Medical University Hospital due to IgG4-RD and various rheumatic and common disorders. The optimal cut-off value of serum IgG4 for a diagnosis of IgG4-RD was 144 mg/dL, and the sensitivity and specificity were 95.10 and 90.76%, respectively. Levels of serum IgG4 were elevated in IgG4-RD, Churg-Strauss syndrome, multicentric Castleman's disease, eosinophilic disorders, and in some patients with rheumatoid arthritis, systemic sclerosis, chronic hepatitis, and liver cirrhosis. The usual cut-off value of 135 mg/dL in AIP is useful for diagnosing whole IgG4-RD, but high levels of serum IgG4 are sometimes observed in not only IgG4-RD but also other rheumatic and common diseases.