IgG4相关的硬化性胆管炎必须与PSC和胆管癌严格区分开，它们的治疗是完全不同的，但IgG4相关的硬化性胆管炎的病理诊断较困难，因此有必要建立一个像血清IgG4这样一项高度特异且无创的标准。通过测量日本中心的IgG4水平建立一个血清IgG4临界值将IgG4相关的硬化性胆管炎从各自的队列中区分。该研究共纳入了344名IgG4相关的硬化性胆管炎患者，并且分别纳入了245名胰腺癌、110名PSC和149名胆管癌患者作对照组。将IgG4相关的硬化性胆管炎患者分为3组：1组（狭窄只发生在胆总管下段）246人，2组（肝内和肝外胆管广泛狭窄）56人，3组和4组（肝门区狭窄）42人，通过对比他们的血清IgG4水平就建立出了这个临界值。当所有的IgG4相关的硬化性胆管炎与对照组相比，从接收机算子特性曲线获得的135mg/dL这个临界值表现出相似的敏感性和特异性，然而当IgG4相关的硬化性胆管炎中亚组与对照组相比时又界定出新的临界值：当3、4型的IgG4相关的硬化性胆管炎与胆管癌相比时，182mg/dL可以将特异性提高到96.6%，而207mg/dL则可以完全将它们分开。血清IgG4水平可用于IgG4相关的硬化性胆管炎与对照组的鉴别。
BACKGROUND AND AIM:
IgG4-related sclerosing cholangitis (IgG4-SC) must be precisely distinguished from primary sclerosing cholangitis and cholangiocarcinoma (CC) because the treatments are completely different. However, the pathological diagnosis of IgG4-SC is difficult. Therefore, highly specific non-invasive criteria such as serum IgG4 should be established. This study established a cut-off for serum IgG4 to differentiate IgG4-SC from respective controls using serum IgG4 levels measured in Japanese centers.
METHODS:
A total of 344 IgG4-SC patients were enrolled in this study. As controls, 245, 110, and 149 patients with pancreatic cancer, primarysclerosing cholangitis, and CC, respectively, were enrolled. IgG4-SC patients were classified into three groups: type 1 (stenosis only in the lower part of the common bile duct), type 2 (stenosis diffusely distributed throughout the intrahepatic and extrahepatic bile ducts), and types 3 and 4 (stenosis in the hilar hepatic region) with 246, 56, and 42 patients, respectively. Serum IgG4 levels were compared, and the cut-offs were established.
RESULTS:
The cut-off obtained from receiver operator characteristic curves showed similar sensitivity and specificity to that of 135 mg/dL when allIgG4-SC and controls were compared. However, a new cut-off value was established when subgroups of IgG4-SC and controls were compared. A cut-off of 182 mg/dL can increase the specificity to 96.6% (4.7% increase) for distinguishing types 3 and 4 IgG4-SC from CC. A cut-off of 207 mg/dL might be useful for completely distinguishing types 3 and 4 IgG4-SC from all CC.
CONCLUSIONS:
Serum IgG4 is useful for the differential diagnosis of IgG4-SC and controls.
吉林大学第一医院肝病科 王红杰 摘译
本文首次发表于[J Gastroenterol Hepatol,2013,28(7):1247-51]
本文首次发表于[J Gastroenterol Hepatol,2013,28(7):1247-51]
Establishment of a serum IgG4 cut-off value for the differential diagnosis of IgG4-related sclerosing cholangitis: AJapanese cohort.
AbstractBACKGROUND AND AIM:
IgG4-related sclerosing cholangitis (IgG4-SC) must be precisely distinguished from primary sclerosing cholangitis and cholangiocarcinoma (CC) because the treatments are completely different. However, the pathological diagnosis of IgG4-SC is difficult. Therefore, highly specific non-invasive criteria such as serum IgG4 should be established. This study established a cut-off for serum IgG4 to differentiate IgG4-SC from respective controls using serum IgG4 levels measured in Japanese centers.
METHODS:
A total of 344 IgG4-SC patients were enrolled in this study. As controls, 245, 110, and 149 patients with pancreatic cancer, primarysclerosing cholangitis, and CC, respectively, were enrolled. IgG4-SC patients were classified into three groups: type 1 (stenosis only in the lower part of the common bile duct), type 2 (stenosis diffusely distributed throughout the intrahepatic and extrahepatic bile ducts), and types 3 and 4 (stenosis in the hilar hepatic region) with 246, 56, and 42 patients, respectively. Serum IgG4 levels were compared, and the cut-offs were established.
RESULTS:
The cut-off obtained from receiver operator characteristic curves showed similar sensitivity and specificity to that of 135 mg/dL when allIgG4-SC and controls were compared. However, a new cut-off value was established when subgroups of IgG4-SC and controls were compared. A cut-off of 182 mg/dL can increase the specificity to 96.6% (4.7% increase) for distinguishing types 3 and 4 IgG4-SC from CC. A cut-off of 207 mg/dL might be useful for completely distinguishing types 3 and 4 IgG4-SC from all CC.
CONCLUSIONS:
Serum IgG4 is useful for the differential diagnosis of IgG4-SC and controls.
