Department of Internal Medicine, Liver Research Institute, Seoul 110-744, South Korea.
World J Gastroenterol. 2013 Jul 7;19(25):4031-8. doi: 10.3748/wjg.v19.i25.4031.
To identify clinical and pathological differences between serum immunoglobulin G4 (IgG4)-positive (SIP) and IgG4-negative (SIN) type 1 autoimmune pancreatitis (AIP) in South Korea.
AIP was diagnosed by the international consensus diagnostic criteria. The medical records and pathology were retrospectively reviewed and IgG4-positive cells were counted in a high power field (HPF). Type I AIP was defined as a high serum level of IgG4 or histological finding. SIN type 1 AIP was defined as a histological evidence of type 1 AIP and a normal serum IgG4 level. The clinical and pathological findings were compared between the two groups. The analysis was performed using Student's t test, Fischer's exact test and Mann-Whitney's U test. A P value of < 0.05 was considered statistically significant. As repeated comparison was made, P values of less than 5% (P < 0.05) were considered significant.
Twenty five patients with definite type 1 AIP (19 histologically and six serologically diagnosed cases) were enrolled. The mean tissue IgG4 concentrations were significantly higher in SIP than SIN group (40 cells per HPF vs 18 cells per HPF, P = 0.02). Among eight SIN patients, the tissue IgG4 concentrations were less than 15 cells per HPF in most of cases, except one. The sensitivity of serum IgG4 was 68% (17 SIP and eight SIN AIP). Other organ involvement was more frequently associated with SIP than SIN AIP (59% vs 26%, P = 0.016). However, the relapse rate and diffuse swelling of the pancreas were not associated with serum IgG4 level. The concentrations of IgG4-positive cells per HPF were higher in SIP than SIN AIP (40 vs 18, P = 0.02).
The sensitivity of serum IgG4 was 68% in type 1 AIP. High serum IgG4 level was associated with other organ involvement and tissue IgG4 concentration but did not affect the relapse rate in type 1 AIP.
在韩国，确定血清免疫球蛋白 G4（IgG4）阳性（SIP）和 IgG4 阴性（SIN）1 型自身免疫性胰腺炎（AIP）之间的临床和病理差异。
根据国际共识诊断标准诊断 AIP。回顾性分析病历和病理资料，在高倍视野（HPF）中计数 IgG4 阳性细胞。1 型 AIP 定义为高血清 IgG4 水平或组织学表现。SIN 型 1 AIP 定义为组织学证据为 1 型 AIP 和正常血清 IgG4 水平。比较两组之间的临床和病理表现。采用 Student's t 检验、Fischer 确切检验和 Mann-Whitney U 检验进行分析。P 值<0.05 被认为具有统计学意义。由于进行了重复比较，因此 P 值小于 5%（P<0.05）被认为具有显著性。
共纳入 25 例明确的 1 型 AIP 患者（19 例组织学诊断和 6 例血清学诊断）。SIP 组的组织 IgG4 浓度明显高于 SIN 组（40 个细胞/HPF 比 18 个细胞/HPF，P=0.02）。在 8 例 SIN 患者中，大多数患者的组织 IgG4 浓度低于 15 个细胞/HPF，除 1 例外。血清 IgG4 的敏感性为 68%（17 例 SIP 和 8 例 SIN AIP）。其他器官受累与 SIP 比 SIN AIP 更常见（59%比 26%，P=0.016）。然而，复发率和胰腺弥漫性肿胀与血清 IgG4 水平无关。SIP 组的 IgG4 阳性细胞浓度高于 SIN AIP 组（40 比 18，P=0.02）。
血清 IgG4 在 1 型 AIP 中的敏感性为 68%。高血清 IgG4 水平与其他器官受累和组织 IgG4 浓度有关，但对 1 型 AIP 的复发率没有影响。
