IgG4相关性疾病实验室研究进展

doi:10.3969/j.issn.1673-8640.2018.011.016

摘要/Abstract

摘要：

IgG4相关性疾病（IgG4-RD）是新近认识的一类表现为纤维化炎性的自身免疫性疾病,其病理特征为IgG4⁺浆细胞浸润、席纹状纤维化、闭塞性静脉炎,常伴有血清IgG4水平升高。机体几乎所有器官都可受累,累及的器官或组织由于慢性炎症及纤维化进程可导致弥漫性肿大。遗传、免疫、微生物感染和分子模拟等多因素参与了IgG4-RD的发病机制。目前,病理诊断仍是IgG4-RD诊断的金标准,但是实验室血清学检测和免疫细胞分析具有定量、便捷和精准的特点,无可替代。文章对IgG4-RD的命名、发病机制和实验室诊断作一综述。

Abstract:

IgG4-related disease （IgG4-RD） is a newly recognized autoimmune disease characterized by fibrotic inflammation. The pathological features are IgG4⁺ plasma cell infiltration,tabular fibrosis and occlusive phlebitis,and IgG4-RD was accompanied with elevated serum IgG4 levels. Most human organs can be affected,which can result in anthorisma due to chronic inflammation and fibrosis. Descendiblity,immue,microbial infection and molecular simulation are involved in its pathogenesis. At present,pathological diagnosis is still the gold standard for the diagnosis of IgG4-RD,but laboratory serological determination and immune cell analysis have the advantages of quantitation,convenience and accuracy,and they are irreplaceable. This review focuses on the naming,pathogenesis and laboratory diagnosis of IgG4-RD.

Key words: IgG4-related disease, Autoimmune disease, Fibrosis, IgG4⁺ plasma cell

中图分类号:

R446.1

殳洁, 盛慧明. IgG4相关性疾病实验室研究进展[J]. 检验医学, 2018, 33(11): 1043-1048.

SHU Jie, SHENG Huiming. Research progress in laboratory diagnosis of IgG4-related diseases[J]. Laboratory Medicine, 2018, 33(11): 1043-1048.

参考文献 43

[1]	UMEHARA H,OKAZAKI K,MASAKI Y,et al.A novel clinical entity,IgG4-related disease(IgG4RD):general concept and details[J]. Mod Rheumatol,2012,22(1):1-14.
[2]	YOSHIDA K,TOKI F,TAKEUCHI T,et al.Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis[J]. Dig Dis Sci,1995,40(7):1561-1568.
[3]	KAMISAWA T,FUNATA N,HAYASHI Y,et al.A new clinicopathological entity of IgG4-related autoimmune disease[J]. J Gastroenterol,2003,38(10):982-984.
[4]	TAKAHASHI H,YAMAMOTO M,SUZUKI C,et al.The birthday of a new syndrome:IgG4-related diseases constitute a clinical entity[J]. Autoimmun Rev,2010,9(9):591-594.
[5]	STONE J H,KHOSROSHAHI A,DESHPANDE V,et al.Recommendations for the nomenclature of IgG4-related disease and its individual organ system manifestations[J]. Arthritis Rheum,2012,64(10):3061-3067.
[6]	NISHIMORI I,TAMAKOSHI A,OTSUKI M,et al.Prevalence of autoimmune pancreatitis in Japan from a nationwide survey in 2002[J]. J Gastroenterol,2007,42(Suppl 18):6-8.
[7]	HUGGETT M T,CULVER E L,KUMAR M,et al.Type 1 autoimmune pancreatitis and IgG4-related sclerosing cholangitis is associated with extrapancreatic organ failure,malignancy,and mortality in a prospective UK cohort[J]. Am J Gastroenterol,2014,109(10):1675-1683.
[8]	LANG D,ZWERINA J,PIERINGER H.IgG4-related disease:current challenges and future prospects[J]. Ther Clin Risk Manag,2016,12:189-199.
[9]	FERNÁNDEZ-CODINA A,MARTÍNEZ-VALLE F,PINILLA B,et al. IgG4-related disease:results from a multicenter Spanish registry[J]. Medicine(Baltimore),2015,94(32):e1275.
[10]	KAMISAWA T,ZEN Y,PILLAI S,et al.IgG4-related disease[J]. Lancet,2015,385(9976):1460-1471.
[11]	INOUE D,YOSHIDA K,YONEDA N,et al.IgG4-related disease:dataset of 235 consecutive patients[J]. Medicine(Baltimore),2015,94(15):e680.
[12]	KAMISAWA T,OKAZAKI K.Diagnosis and treatment of IgG4-related disease[J]. Curr Top Microbiol Immunol,2017,401:19-33.
[13]	DIVATIA M,KIM S A,RO J Y.IgG4-related sclerosing disease,an emerging entity:a review of a multi-system disease[J]. Yonsei Med J,2012,53(1):15-34.
[14]	MAHAJAN V S,MATTOO H,DESHPANDE V,et al.IgG4-related disease[J]. Annu Rev Pathol,2014,9:315-347.
[15]	SASAKI T,AKIYAMA M,KANEKO Y,et al.Risk factors of relapse following glucocorticoid tapering in IgG4-related disease[J]. Clin Exp Rheumatol,2018,36
	[Suppl 112.(3)]:186-189.
[16]	ZHANG L,SMYRK T C.Autoimmune pancreatitis and IgG4-related systemic diseases[J]. Int J Clin Exp Pathol,2010,3(5):491-504.
[17]	KAMISAWA T,SHIMOSEGAWA T,OKAZAKI K,et al.Standard steroid treatment for autoimmune pancreatitis[J]. Gut,2009,58(11):1504-1507.
[18]	CARRUTHERS M N,TOPAZIAN M D,KHOSROSHAHI A,et al.Rituximab for IgG4-related disease:a prospective,open-label trial[J]. Ann Rheum Dis,2015,74(6):1171-1177.
[19]	TANG S H,LIN M H,DU J S,et al.IgG4-related disease with bone marrow involvement mimicking multiple myeloma[J]. Br J Haematol,2017,177(5):673.
[20]	STONE J H,CHAN J K,DESHPANDE V,et al.IgG4-related disease[J]. Int J Rheumatol,2013,2013:532612.
[21]	PERUGINO C A,MATTOO H,MAHAJAN V S,et al.Emerging treatment models in rheumatology:IgG4-related disease:insights into human immunology and targeted therapies[J]. Arthritis Rheumatol,2017,69(9):1722-1732.
[22]	YAMAMOTO M,TAKAHASHI H,SHINOMURA Y.Mechanisms and assessment of IgG4-related disease:lessons for the rheumatologist[J]. Nat Rev Rheumatol,2014,10(3):148-159.
[23]	AKIYAMA M,YASUOKA H,YOSHIMOTO K,et al.Interleukin-4 contributes to the shift of balance of IgG subclasses toward IgG4 in IgG4-related disease[J]. Cytokine,2018,110:416-419.
[24]	FURUKAWA S,MORIYAMA M,MIYAKE K,et al.Interleukin-33 produced by M2 macrophages and other immune cells contributes to Th2 immune reaction of IgG4-related disease[J]. Sci Rep,2017,7:42413.
[25]	刘燕鹰,张文. 第三届国际IgG4相关性疾病和纤维化疾病研讨会纪要[J]. 中华临床免疫和变态反应杂志,2017,11(1):99-100.
[26]	FUKUI Y,UCHIDA K,SAKAGUCHI Y,et al.Possible involvement of Toll-like receptor 7 in the development of type 1 autoimmune pancreatitis[J]. J Gastroenterol,2015,50(4):435-444.
[27]	AKITAKE R,WATANABE T,ZAIMA C,et al.Possible involvement of T helper type 2 responses to Toll-like receptor ligands in IgG4-related sclerosing disease[J]. Gut,2010,59(4):542-545.
[28]	YAMAMOTO M,NAISHIRO Y,SUZUKI C,et al.Proteomics analysis in 28 patients with systemic IgG4-related plasmacytic syndrome[J]. Rheumatol Int,2010,30(4):565-568.
[29]	ITO A,SHIMADA H,ISHIKAWA K,et al.Association between HLA-DRB10405,-DQB10401 and -DQA1*0303 alleles and lamotrigine-induced cutaneous adverse drug reactions. A pilot case-control study from Japan[J]. J Affect Disord,2015,179:47-50.
[30]	PARK D H,KIM M H,OH H B,et al.Substitution of aspartic acid at position 57 of the DQbeta1 affects relapse of autoimmune pancreatitis[J]. Gastroenterology,2008,134(2):440-446.
[31]	于立杰,陈雨,张盼盼,等. IgG4相关疾病与人类白细胞抗原-DR、DQ等位基因的相关性[J]. 中华临床免疫和变态反应杂志,2016,10(4):346-350.
[32]	LI M,ZHOU Q,YANG K,et al.Rare case of Helicobacter pylori-positive multiorgan IgG4-related disease and gastric cancer[J]. World J Gastroenterol,2015,21(11):3429-3434.
[33]	CULVER E L,SMIT W L,EVANS C,et al.No evidence to support a role for Helicobacter pylori infection and plasminogen binding protein in autoimmune pancreatitis and IgG4-related disease in a UK cohort[J]. Pancreatology,2017,17(3):395-402.
[34]	BLAGOVA O V,NEDOSTUP A V,SHERSTNEVA L V,et al.Takayasu's disease in an IgG4-positive patient with tuberculosis,pulmonary hemorrhage,recurrent myocarditis,and transient bilateral visual impairments[J]. Ter Arkh,2017,89(3):85-93.
[35]	HAO M,LI W,YI L,et al.Hybrid kappa\lambda antibody is a new serological marker to diagnose autoimmune pancreatitis and differentiate it from pancreatic cancer[J]. Sci Rep,2016,6:27415.
[36]	CULVER E L,SADLER R,SIMPSON D,et al.Elevated serum IgG4 levels in diagnosis,treatment response,organ involvement,and relapse in a prospective IgG4-related disease UK cohort[J]. Am J Gastroenterol,2016,111(5):733-743.
[37]	DESHPANDE V,ZEN Y,CHAN J K,et al.Consensus statement on the pathology of IgG4-related disease[J]. Mod Pathol,2012,25(9):1181-1192.
[38]	MARTÍNEZ-VALLE F,FERNÁNDEZ-CODINA A,PINAL-FERNÁNDEZ I,et al. IgG4-related disease:evidence from six recent cohorts[J]. Autoimmun Rev,2017,16(2):168-172.
[39]	YU K H,CHAN T M,TSAI P H,et al.Diagnostic performance of serum IgG4 levels in patients with IgG4-related disease[J]. Medicine(Baltimore),2015,94(41):e1707.
[40]	MASAKI Y,KUROSE N,YAMAMOTO M,et al.Cutoff values of serum IgG4 and histopathological IgG4+ plasma cells for diagnosis of patients with IgG4-related disease[J]. Int J Rheumatol,2012,2012:580814.
[41]	LIN W,ZHANG P,CHEN H,et al.Circulating plasmablasts/plasma cells:a potential biomarker for IgG4-related disease[J]. Arthritis Res Ther,2017,19(1):25.
[42]	WALLACE Z S,DESHPANDE V,MATTOO H,et al.IgG4-related disease:clinical and laboratory features in one hundred twenty-five patients[J]. Arthritis Rheumatol,2015,67(9):2466-2475.
[43]	CARRUTHERS M N,KHOSROSHAHI A,AUGUSTIN T,et al.The diagnostic utility of serum IgG4 concentrations in IgG4-related disease[J]. Ann Rheum Dis,2015,74(1):14-18.