自身免疫性胰腺炎与胰腺癌的鉴别：抗淀粉酶和抗碳酸酐酶II自身抗体的作用

Differentiation of autoimmune pancreatitis from pancreas cancer: utility of anti-amylase and anti-carbonic anhydrase II autoantibodies.

作者信息

Sánchez-Castañón M, de Las Heras-Castaño G, Gómez C, López-Hoyos M

机构信息

Servicio Inmunología, Hospital Universitario Marqués de Valdecilla-IFIMAV, Avda. Valdecilla s/n, 39008 Santander, Spain.

Gastroenterology Service, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain.

出版信息

Auto Immun Highlights. 2011 Sep 7;3(1):11-7. doi: 10.1007/s13317-011-0024-x. eCollection 2012 Apr.

DOI:10.1007/s13317-011-0024-x

PMID:26000123

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4389022/

Abstract

PURPOSE

To investigate the utility of different combinations of serum anti-carbonic anhydrase II antibodies (CA II Abs), anti-α amylase antibodies (AMY-α Abs) and IgG4 levels for the diagnosis of autoimmune pancreatitis (AIP).

METHODS

We recruited 93 patients with clinical suspicion for AIP and 94 patients as control groups between June 2003 and October 2009. Serum antibodies were measured using homemade enzyme linked immunosorbent assay and IgG4 levels were determined by nephelometry.

RESULTS

Both CA-II Abs and AMY-α Abs had the highest sensitivity (83%) although AMY-α Abs (89%) were more specific than CA-II Abs (75%). The presence of increased IgG4 levels was the most specific serological marker (94%), but it had the lowest sensitivity (58%). The combination of the three serological markers altogether had the highest specificity (99%) and positive predictive value (PPV) (86%), but they had a rather low sensitivity (50%). When we combined CA-II Abs and AMY-α Abs without IgG4 levels, we got the highest sensitivity (75%) and negative predictive value (98%) but the specificity and the PPV decreased to 93 and 50%, respectively. Importantly, AMY-α Abs were not detected in pancreas cancer.

CONCLUSIONS

The presence of serum CA-II and AMY-α Abs with increased IgG4 is useful in the differential diagnosis of AIP from pancreatic cancer.

摘要

目的

探讨血清抗碳酸酐酶II抗体（CA II Abs）、抗α淀粉酶抗体（AMY-α Abs）及IgG4水平的不同组合对自身免疫性胰腺炎（AIP）诊断的效用。

方法

2003年6月至2009年10月期间，我们招募了93例临床疑似AIP的患者和94例作为对照组的患者。使用自制酶联免疫吸附测定法检测血清抗体，用散射比浊法测定IgG4水平。

结果

CA-II Abs和AMY-α Abs均具有最高的敏感性（83%），尽管AMY-α Abs（89%）比CA-II Abs（75%）更具特异性。IgG4水平升高是最具特异性的血清学标志物（94%），但其敏感性最低（58%）。三种血清学标志物联合使用时具有最高的特异性（99%）和阳性预测值（PPV）（86%），但敏感性相当低（50%）。当我们将CA-II Abs和AMY-α Abs联合而不考虑IgG4水平时，我们获得了最高的敏感性（75%）和阴性预测值（98%），但特异性和PPV分别降至93%和50%。重要的是，在胰腺癌中未检测到AMY-α Abs。