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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Utility of Serum Immunoglobulin G4 in Distinguishing Immunoglobulin G4-Associated Cholangitis from Cholangiocarcinoma
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Utility of Serum Immunoglobulin G4 in Distinguishing Immunoglobulin G4-Associated Cholangitis from Cholangiocarcinoma

机译：血清免疫球蛋白G4在区分免疫球蛋白G4相关胆管炎和胆管癌中的作用

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摘要

Elevated serum immunoglobulin G4 (sIgG4) is a feature of autoimmune pancreatitis (AIP) and IgG4-associated cholangitis (IAC); a >2-fold increase in sIgG4 is considered highly specific for these disorders. Many patients with IAC present with biliary strictures and obstructive jaundice, making cholangiocarcinoma (CCA) an important differential diagnosis. We determined the value of sIgG4 in distinguishing IAC from CCA. sIgG4 levels were measured in a test cohort of 126 CCA and 50 IAC patients. The results were confirmed in a validation cohort of 161 CCA and 47 IAC patients. Of the 126 CCA patients in the test cohort, 17 (13.5%) had elevated sIgG4 (>140 mg/dL) and four (3.2%) had a >2-fold (>280 mg/dL) increase. Primary sclerosing cholangitis (PSC) was present in 31/126 CCA patients, of whom seven (22.6%) had elevated sIgG4 and two (6.5%) had a >2-fold elevation. Of the 50 IAC patients, 39 (78.0%) had elevated sIgG4 and 25 (50.0%) had a >2-fold increase. The results in the validation cohort were consistent with those of the test cohort. Conclusion: Although elevated sIgG4 levels are characteristic of IAC, some patients with CCA, particularly with PSC, have elevated sIgG4 levels, including a small percentage with a more than a 2-fold increase in sIgG4. Therefore, sIgG4 elevation alone does not exclude the diagnosis of CCA. Depending on the prevalence of the two diagnoses, the use of a 2-fold cutoff for sIgG4 may not reliably distinguish IAC from CCA. At a cutoff of 4 times the upper limit of normal, sIgG4 is 100% specific for IAC.
机译：血清免疫球蛋白G4（sIgG4）升高是自身免疫性胰腺炎（AIP）和IgG4相关胆管炎（IAC）的特征; sIgG4增加> 2倍被认为对这些疾病高度特异性。许多IAC患者出现胆道狭窄和梗阻性黄疸，使胆管癌（CCA）成为重要的鉴别诊断。我们确定了sIgG4在区分IAC和CCA中的价值。在126名CCA和50名IAC患者的测试队列中测量了sIgG4水平。在161名CCA和47名IAC患者的验证队列中证实了结果。在测试队列的126名CCA患者中，有17名（13.5％）的sIgG4（> 140 mg / dL）升高，而四名（3.2％）的sIgG4升高了2倍（> 280 mg / dL）。 31/126 CCA患者中存在原发性硬化性胆管炎（PSC），其中7例（22.6％）的sIgG4升高，而2例（6.5％）的> 2倍升高。在50例IAC患者中，有39例（78.0％）的sIgG4升高，而25例（50.0％）的sIgG4增加> 2倍。验证队列中的结果与测试队列中的结果一致。结论：尽管IAC的特征是sIgG4水平升高，但某些CCA患者，特别是PSC患者，sIgG4水平升高，其中小部分患者的sIgG4水平增加了2倍以上。因此，仅sIgG4升高并不排除CCA的诊断。根据两次诊断的普遍程度，对sIgG4使用2倍截止值可能无法可靠地将IAC与CCA区分开。在正常上限上限的4倍时，sIgG4对IAC具有100％的特异性。

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