血清IgG4和IgG4/IgG比值诊断Ⅰ型自身免疫性胰腺炎的最佳临界值及性能评价

doi:10.3969/j.issn.1673-8640.2019.04.007

摘要/Abstract

摘要：

目的探讨血清免疫球蛋白（Ig）G4水平和IgG4/IgG比值诊断Ⅰ型自身免疫性胰腺炎（AIP）的最佳临界值及性能。方法采用免疫散射比浊法检测47例Ⅰ型AIP患者、109例胰腺胆管恶性肿瘤患者（疾病对照组）及99名正常对照者的血清IgG亚类（IgG1、IgG2、IgG3、IgG4）水平。采用受试者工作特征（ROC）曲线评价血清IgG4水平和IgG4/IgG比值鉴别诊断Ⅰ型AIP的效能,计算曲线下面积（AUC）并确定最佳临界值。结果 Ⅰ型AIP组血清IgG2、IgG4、IgG水平和IgG4/IgG比值均高于正常对照组（P<0.001）;疾病对照组血清IgG1、IgG3、IgG4水平和IgG4/IgG比值均低于正常对照组（P<0.05）。Ⅰ型AIP组中血清IgG4水平升高者占95.7%,明显高于疾病对照组（3.7%）和正常对照组（2.0%）（P<0.001）;疾病对照组和正常对照组之间差异无统计学意义（P>0.05）。ROC曲线分析显示,血清IgG4鉴别诊断Ⅰ型AIP的AUC为0.992,最佳临界值为1 740 mg/L,敏感性、特异性和准确性分别为97.9%、96.2%和96.5%;IgG4/IgG比值鉴别诊断Ⅰ型AIP的AUC为0.988,最佳临界值为0.103,敏感性、特异性和准确性分别为97.9%、93.8%、94.5%。血清IgG4与IgG4/IgG比值鉴别诊断Ⅰ型AIP的AUC差异无统计学意义（P>0.05）。结论血清IgG4水平及IgG4/IgG比值对于诊断Ⅰ型AIP均有重要价值。

关键词: 免疫球蛋白G4, 免疫球蛋白G4/免疫球蛋白G比值, 自身免疫性胰腺炎, 胰腺癌, 胆管癌

Abstract:

Objective To investigate the optimal cut-off value and performance of serum immunoglobulin（Ig）G4 and IgG4/IgG ratio in the diagnosis of typeⅠ autoimmune pancreatitis（AIP）. Methods Serum IgG subclass（IgG1,IgG2,IgG3 and IgG4） levels in 47 patients with type Ⅰ AIP,109 patients with pancreatic cancer or cholangiocarcinoma（disease control group） and 99 healthy subjects（healthy control group） were determined by immunonephelometry. Receiver operating characteristic（ROC） curve was used to identify the optimal cut-off values and the area under curve（AUC） of serum IgG4 and IgG4/IgG ratio for the diagnosis of typeⅠ AIP. Results The levels of serum IgG2,IgG4,IgG and IgG4/IgG ratio in typeⅠ AIP group were higher than those in healthy control group（P<0.001）. The levels of serum IgG1,IgG3,IgG4 and IgG4/IgG ratio in disease control group were lower than those in healthy control group（P<0.05）. The proportion of elevated IgG4 level in type Ⅰ AIP group（95.7%） was higher than those in disease control group（3.7%） and healthy control group（2.0%）（P<0.001）,and there was no statistical significance between disease and healthy control groups（P>0.05）. The AUC of serum IgG4 for the diagnosis of typeⅠ AIP was 0.992,and the optimal cut-off value was 1 740 mg/L. The sensitivity,specificity and accuracy were 97.9%,96.2% and 96.5%. The AUC of IgG4/IgG ratio for the diagnosis of typeⅠ AIP was 0.988,the optimal cut-off value was 0.103,and the sensitivity,specificity and accuracy were 97.9%,93.8% and 94.5%. There was no statistical significance for the AUC of serum IgG4 and IgG4/IgG ratio in the diagnosis of type Ⅰ AIP（P>0.05）. Conclusions Serum IgG4 level and IgG4/IgG ratio play roles in the diagnosis of typeⅠ AIP.

Key words: Immunoglobulin G4, Immunoglobulin G4/immunoglobulin G ratio, Autoimmune pancreatitis, Pancreatic cancer, Cholangiocarcinoma

中图分类号:

R446.1

夏长胜, 樊春红, 王辉. 血清IgG4和IgG4/IgG比值诊断Ⅰ型自身免疫性胰腺炎的最佳临界值及性能评价[J]. 检验医学, 2019, 34(4): 322-326.

XIA Changsheng, FAN Chunhong, WANG Hui. Evaluation of optimal cut-off value and performance of serum IgG4 and IgG4/IgG ratio in the diagnosis of typeⅠ autoimmune pancreatitis[J]. Laboratory Medicine, 2019, 34(4): 322-326.

图/表 2

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组别	例数	IgG1（mg/L）	IgG2（mg/L）	IgG3（mg/L）
Ⅰ型AIP组	47	8 520（6 440~11 440）	5 710（4 140~6 740）^**	381（200~632）
疾病对照组	109	7 230（6 055~8 345）^*	4 320（2 900~5 785）	237（141~452）^*
正常对照组	99	7 670（6 810~9 240）	4 210（3 230~5 570）	321（215~505）
组别	IgG4（mg/L）		IgG（mg/L）	IgG4/IgG比值
Ⅰ型AIP组	6 410（3 170~12 000）^**		23 562（16 000~30 799）^**	0.287（0.214~0.443）^**
疾病对照组	451（236~788）^*		12 544（10 355~15 392）	0.037（0.020~0.058）^*
正常对照组	625（314~921）		13 146（11 367~14 556）	0.046（0.030~0.071）

组别	例数	IgG1（mg/L）	IgG2（mg/L）	IgG3（mg/L）
Ⅰ型AIP组	47	8 520（6 440~11 440）	5 710（4 140~6 740）^**	381（200~632）
疾病对照组	109	7 230（6 055~8 345）^*	4 320（2 900~5 785）	237（141~452）^*
正常对照组	99	7 670（6 810~9 240）	4 210（3 230~5 570）	321（215~505）
组别	IgG4（mg/L）		IgG（mg/L）	IgG4/IgG比值
Ⅰ型AIP组	6 410（3 170~12 000）^**		23 562（16 000~30 799）^**	0.287（0.214~0.443）^**
疾病对照组	451（236~788）^*		12 544（10 355~15 392）	0.037（0.020~0.058）^*
正常对照组	625（314~921）		13 146（11 367~14 556）	0.046（0.030~0.071）