Department of Immunology, Churchill Hospital, John Radcliffe Hospital, Oxford Radcliffe Trust, Oxford, UK.
Eur J Gastroenterol Hepatol. 2011 Feb;23(2):139-45. doi: 10.1097/meg.0b013e3283423486.
Autoimmune pancreatitis (AIP) is recognised as an end organ manifestation of the systemic condition known as IgG4-sclerosing disease. One major characteristic of this disease, regardless of its location in the body, is the presence of high levels of circulating serum IgG, in particular IgG4 antibody. In the case of AIP, differential diagnosis from other conditions of the pancreas and biliary system, particularly cancers, can be difficult, but could result in avoiding invasive procedures and surgery. Earlier studies have evaluated the use of checking IgG4 levels in AIP diagnosis; these have produced variable results.
To further assess the diagnostic significance of serum IgG4 levels in AIP and investigate its value in differentiating from cancer of the gastroenterological system.
A retrospective study of 196 IgG4-requested samples from a 24-month period was examined. Samples were sorted into confirmed AIP, cancer or other pancreatic conditions including primary sclerosing cholangitis.
Patients with AIP possessed a mean serum IgG level that was significantly higher compared with all other groups (mean serum IgG level=19.0 g/l+/-2.5, P<0.001). The mean serum IgG4 level of AIP patients was also significantly higher compared with all other conditions including cancer patients (mean IgG4 level=3.7 g/l+/-0.5, P<0.001).
This data lends support to circulating IgG4 levels only being used as an accompanying diagnostic marker to imaging, histology and clinical presentation. In particular, this may help in differentiating between AIP and pancreatic carcinoma.
自身免疫性胰腺炎（AIP）被认为是一种全身性疾病——即 IgG4 硬化性疾病的终末器官表现。这种疾病的一个主要特征是，无论其在体内的位置如何，都存在循环血清 IgG 水平升高，尤其是 IgG4 抗体升高。在 AIP 的情况下，与胰腺和胆道系统的其他疾病（特别是癌症）的鉴别诊断可能具有挑战性，但可以避免侵入性操作和手术。早期研究已经评估了检查 IgG4 水平在 AIP 诊断中的应用；这些研究结果不一。
进一步评估血清 IgG4 水平在 AIP 诊断中的诊断意义，并探讨其在鉴别消化系统癌症中的价值。
对 24 个月期间的 196 例 IgG4 请求样本进行回顾性研究。将样本分为确诊的 AIP、癌症或其他胰腺疾病，包括原发性硬化性胆管炎。
AIP 患者的血清 IgG 水平明显高于所有其他组（平均血清 IgG 水平=19.0 g/l+/-2.5，P<0.001）。AIP 患者的血清 IgG4 水平也明显高于所有其他疾病（包括癌症患者）（平均 IgG4 水平=3.7 g/l+/-0.5，P<0.001）。
该数据支持仅将循环 IgG4 水平用作影像学、组织学和临床表现的辅助诊断标志物。特别是，这可能有助于区分 AIP 和胰腺腺癌。
