Kamisawa Terumi, Imai Mitsuho, Egawa Naoto, Tsuruta Kouji, Okamoto Atsutake
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Eur J Gastroenterol Hepatol. 2008 Dec;20(12):1167-70. doi: 10.1097/MEG.0b013e3283069dc2.
Serum IgG4 levels are frequently elevated in patients with autoimmune pancreatitis (AIP). AIP is sometimes associated with various extrapancreatic lesions. This study examined whether there is a correlation between serum IgG4 levels and associated extrapancreatic lesions in AIP patients.
Serum IgG4 levels were measured in 40 AIP patients before therapy. In these patients, four associated extrapancreatic lesions (sclerosing cholangitis, sclerosing cholecystitis, sclerosing sialadenitis, and retroperitoneal fibrosis) and clinical factors, such as age, sex ratio, enlargement of the pancreas, and initial symptoms, were retrospectively assessed.
The mean serum IgG4 level of the 40 AIP patients was 411+/-448 mg/dl. On the basis of the receiver operator characteristic curve data, the optimal cutoff value for the serum IgG4 to distinguish between AIP patients with and without extrapancreatic lesions was 220 mg/dl; 18 (78%) of 23 patients whose serum IgG4 was more than or equal to 220 mg/dl had extrapancreatic lesions, whereas four (24%) of 17 patients whose serum IgG4 was less than 220 mg/dl had extrapancreatic lesions (P=0.0011). No significant differences between the two groups in age, sex, the frequency of pancreatic enlargement or obstructive jaundice, and associated sialadenitis, retroperitoneal fibrosis, and diabetes mellitus were identified. Sclerosing cholangitis and cholecystitis were more frequent in patients with serum IgG4 levels of more than or equal to 220 mg/dl than in those with a lower serum IgG4 level (P=0.0002 and 0.0204, respectively). The number of associated extrapancreatic lesions was significantly greater in patients with a high-serum IgG4 level.
AIP patients with serum IgG4 levels of more than or equal to 220 mg/dl frequently have extrapancreatic lesions.
自身免疫性胰腺炎（AIP）患者的血清IgG4水平常升高。AIP有时与各种胰腺外病变相关。本研究调查了AIP患者血清IgG4水平与相关胰腺外病变之间是否存在相关性。
在40例AIP患者治疗前测量其血清IgG4水平。回顾性评估这些患者的四种相关胰腺外病变（硬化性胆管炎、硬化性胆囊炎、硬化性涎腺炎和腹膜后纤维化）以及临床因素，如年龄、性别比例、胰腺肿大和初始症状。
40例AIP患者的血清IgG4平均水平为411±448mg/dl。根据受试者工作特征曲线数据，区分有和无胰腺外病变的AIP患者的血清IgG4最佳截断值为220mg/dl；血清IgG4大于或等于220mg/dl的23例患者中有18例（78%）有胰腺外病变，而血清IgG4低于220mg/dl的17例患者中有4例（24%）有胰腺外病变（P=0.0011）。两组在年龄、性别、胰腺肿大或梗阻性黄疸的发生率以及相关涎腺炎、腹膜后纤维化和糖尿病方面无显著差异。血清IgG4水平大于或等于220mg/dl的患者中硬化性胆管炎和胆囊炎比血清IgG4水平较低的患者更常见（分别为P=0.0002和0.0204）。血清IgG4水平高的患者相关胰腺外病变的数量明显更多。
血清IgG4水平大于或等于220mg/dl的AIP患者常伴有胰腺外病变。
