Department of Medicine, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia.
Libyan J Med. 2010 Jan 25;5. doi: 10.3402/ljm.v5i0.4857.
Hypergammaglobulinemia is frequently observed in patients with chronic liver disease (CLD) of different causes. On the other hand, elevated levels of serum immunoglobulin G (IgG) are the best diagnostic marker for autoimmune hepatitis (AIH). Thus, the ability to distinguish AIH patients from patients with other liver disease, especially patients with advanced liver cirrhosis, is important since most AIH patients will a have favorable treatment response if diagnosed properly.
We conducted this study to evaluate the significance of elevated IgG levels in patients with non-autoimmune CLD and to compare these IgG levels with those in patients with AIH upon diagnosis.
The serum IgG levels in 27 patients with AIH determined at the time of diagnosis were compared to the serum IgG levels in 27 patients with other CLDs of variable severity at the King Abdul Aziz University Hospital in Jeddah, Saudi Arabia. Severity of the disease was evaluated in all patients.
We found that the patients in the CLD group with decompensated cirrhosis had significantly higher serum IgG levels compared to the compensated CLD patients (p <0.02). In addition, the AIH patients had significantly higher serum IgG levels than the non-autoimmune hepatitis CLD patients and the decompensated cirrhosis patients in the CLD group (p <0.001 and p <0.044, respectively). Most patients with elevated serum IgG of the AIH group (67%) and the CLD group (75%) had significant hypergammaglobulinemia, not just isolated elevated IgG levels.
Elevated serum IgG levels with hypergammaglobulinemia are commonly found in patients with advanced CLD. The differentiation of such cases from AIH is important in order to avoid misdiagnosis and confusion with AIH.
不同病因导致的慢性肝脏疾病（CLD）患者常伴有高球蛋白血症。另一方面，血清免疫球蛋白 G（IgG）水平升高是自身免疫性肝炎（AIH）的最佳诊断标志物。因此，将 AIH 患者与其他肝病患者，尤其是晚期肝硬化患者区分开来非常重要，因为如果正确诊断，大多数 AIH 患者的治疗反应会较好。
本研究旨在评估非自身免疫性 CLD 患者 IgG 水平升高的意义，并比较这些 IgG 水平与 AIH 患者初诊时的 IgG 水平。
在沙特阿拉伯吉达的阿卜杜勒阿齐兹国王大学医院，比较了 27 例 AIH 患者诊断时的血清 IgG 水平和 27 例不同严重程度的其他 CLD 患者的血清 IgG 水平。所有患者均进行了病情严重程度评估。
我们发现，CLD 组失代偿性肝硬化患者的血清 IgG 水平明显高于代偿性 CLD 患者（p <0.02）。此外，AIH 患者的血清 IgG 水平明显高于非自身免疫性肝炎 CLD 患者和 CLD 组失代偿性肝硬化患者（p <0.001 和 p <0.044，分别）。AIH 组（67%）和 CLD 组（75%）大多数高血清 IgG 患者均伴有高球蛋白血症，而不仅仅是孤立性 IgG 水平升高。
晚期 CLD 患者常伴有血清 IgG 水平升高伴高球蛋白血症。为避免误诊和与 AIH 混淆，区分这些病例非常重要。
