内镜下十二指肠乳头 FOXP3+Treg 上调的活组织检查在自身免疫性胰腺炎和胰腺癌鉴别诊断中的作用。

Usefulness of endoscopic biopsy using FOXP3+ Treg up-regulation in the duodenal papilla in the differential diagnosis between autoimmune pancreatitis and pancreatic cancer.

机构信息

Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, 236-0004, Japan.

出版信息

J Hepatobiliary Pancreat Sci. 2011 May;18(3):414-21. doi: 10.1007/s00534-010-0359-0.

DOI:10.1007/s00534-010-0359-0

PMID:21113630

Abstract

BACKGROUND AND STUDY AIMS

Expression of the forkhead/winged helix family of transcription factor P3+ regulatory T cells (FOXP3(+) Treg), a master gene of regulatory T cells (Treg) is observed in patients with autoimmune pancreatitis (AIP). We investigated the usefulness of detection of FOXP3(+) Treg in the main duodenal papilla for differential diagnosis between AIP and pancreatic cancer (Pca).

PATIENTS AND METHODS

Firstly, we determined the cut-off value of FOXP3 expression in duodenal papilla taken from the patients with AIP (n = 22) and chronic pancreatitis (n = 21). Data from 32 patients with AIP and 30 patients with Pca who had undergone endoscopic biopsy were then studied. The numbers of FOXP3(+) Treg-positive lymphocytes and IgG4-positive plasma cells per high-power field (HPF) were counted in all the histopathological specimens.

RESULTS

The areas under the receiver-operating characteristic (AUROC) curves for FOXP3(+) and IgG4 expression were 0.934 and 0.953, respectively. Cut-off values calculated based on AUROC data were 14/HPF in FOXP3 and 10/HPF in IgG4. Seropositivity for IgG4 was observed in 22 out of the 31 patients with AIP (sensitivity 71.0%, specificity 84.6%, accuracy 75.0%). Significant infiltration of the major duodenal papilla by FOXP3(+) lymphocytes (≥ 14/HPF) was recognized in 18 of the 32 patients with AIP (sensitivity 56.3%, specificity 100%, accuracy 77.4%). Significant infiltration of the major duodenal papilla by IgG4-positive plasma cells (≥ 10/HPF) was recognized in 27 of the 32 patients with AIP (sensitivity 84.4%, specificity 80.0%, accuracy 82.3%).

CONCLUSIONS

Observation of FOXP3(+) cells in the main duodenal papilla may be useful in the differential diagnosis between AIP and Pca.

摘要

背景和研究目的

叉头框/翼状螺旋转录因子 P3+调节性 T 细胞（FOXP3+Treg）的表达在自身免疫性胰腺炎（AIP）患者中观察到。我们研究了检测主要十二指肠乳头中的 FOXP3+Treg 对 AIP 和胰腺癌（Pca）之间的鉴别诊断的有用性。

患者和方法

首先，我们确定了来自 AIP（n=22）和慢性胰腺炎（n=21）患者的十二指肠乳头中 FOXP3 表达的截断值。然后研究了 32 例 AIP 和 30 例接受内镜活检的 Pca 患者的数据。在所有组织病理学标本中，计算 FOXP3+Treg 阳性淋巴细胞和 IgG4 阳性浆细胞的每高倍视野（HPF）数。

结果

FOXP3（+）和 IgG4 表达的受试者工作特征（ROC）曲线下面积分别为 0.934 和 0.953。基于 ROC 数据计算的截断值为 FOXP3 为 14/HPF，IgG4 为 10/HPF。31 例 AIP 患者中有 22 例 IgG4 血清阳性（敏感性 71.0%，特异性 84.6%，准确性 75.0%）。在 32 例 AIP 患者中，18 例（敏感性 56.3%，特异性 100%，准确性 77.4%）主要十二指肠乳头明显浸润 FOXP3+淋巴细胞（≥14/HPF）。在 32 例 AIP 患者中，27 例（敏感性 84.4%，特异性 80.0%，准确性 82.3%）主要十二指肠乳头 IgG4 阳性浆细胞浸润明显（≥10/HPF）。