Wu X, Luo Q L, Li G D
Department of pathology, West China Hospital, Sichuan University, Chengdu 610041, china.
Zhonghua Yan Ke Za Zhi. 2016 Apr 11;52(4):256-62. doi: 10.3760/cma.j.issn.0412-4081.2016.04.005.
To study the clinicopathologic features of IgG4-related ocular disease and differentiated diagnosis with non-IgG4-related ocular disorders.
Forty-three cases were selected from the Department of Pathology, West China Hospital, Sichuan University from December 2008 to January 2015 with retrospective series case study. The clinical manifestation, laboratory examination, imaging findings, treatment and histopathological characteristics were analyzed. According to the diagnostic criteria for IgG4-related ocular disease in 2014 and relevant literatures, our cases were divided into two groups: IgG4-related ocular disease (23 samples from 18patients) and non-IgG4-related ocular disease (31 samples from 25 patients). The male-to-female ratio, the periductal fibrosis and the orbital lesion area was analyzed by Pearson chi-square. The Immunohistochemistry of IgG4+/HPF, IgG+/HPF and IgG4+/IgG+ ratio and age was analyzed by two sample t test. The involved structural tissue and the infiltration of eosinophils and lymphocytes and plasma cells was analyzed by signed-rank test.
The significant statistic differences were observed between these two groups in immunohistochemical staining of IgG4 (>40/HPF) (t=12.17, P<0.01), IgG (t=2.91, P<0.01) and IgG4+/IgG+ ratio (≥40%) (t=16.98, P<0.01), the lymphocytic and plasmacytic infiltration (F=3.62, P=0.03),the periductal fibrosis(F=4.71 , P=0.03), the involved region of orbit (t=1.11, P=0.01), but not in the mean age and male-to-female ratio (t=1.09, P=0.58). IgG4 ROD should be distinguished form the non-specific inflammation disorders, lymphoma and so on.
IgG4-related ocular disease often arises from middle-old man, characterized by bilateral orbital painless swelling and abundant IgG4+ plasma cells infiltration. Nearly all orbital tissue could be involved by IgG4-related ocular disease, especially lacrimal gland. But the characteristic obliterating phlebitis were not seen. The immunohistochemical staining of IgG4 and IgG plays an important role in differentiating IgG4-related ocular disease from non-IgG4-related ocular disorders. Combining clinical manifestation, laboratory examination, imaging findings with histopathology is helpful for diagnosis and differential diagnosis. (Chin J Ophthalmol, 2016, 52: 256-262).
研究IgG4相关性眼病的临床病理特征并与非IgG4相关性眼病进行鉴别诊断。
选取2008年12月至2015年1月四川大学华西医院病理科的43例病例进行回顾性系列病例研究。分析其临床表现、实验室检查、影像学表现、治疗及组织病理学特征。根据2014年IgG4相关性眼病的诊断标准及相关文献，将病例分为两组：IgG4相关性眼病组（18例患者的23份标本）和非IgG4相关性眼病组（25例患者的31份标本）。采用Pearson卡方检验分析男女比例、导管周围纤维化及眼眶病变面积。采用两样本t检验分析IgG4⁺/HPF、IgG⁺/HPF、IgG4⁺/IgG⁺比值及年龄。采用符号秩和检验分析受累结构组织及嗜酸性粒细胞、淋巴细胞和浆细胞的浸润情况。
两组在IgG4免疫组化染色（>40/HPF）（t = 12.17，P < 0.01）、IgG（t = 2.91，P < 0.01）及IgG4⁺/IgG⁺比值（≥40%）（t = 16.98，P < 0.01）、淋巴细胞和浆细胞浸润（F = 3.62，P = 0.03）、导管周围纤维化（F = 4.71，P = 0.03）、眼眶受累区域（t = 1.11，P = 0.01）方面存在显著统计学差异，但在平均年龄和男女比例方面无差异（t = 1.09，P = 0.58）。IgG4相关性眼眶病应与非特异性炎症性疾病、淋巴瘤等相鉴别。
IgG4相关性眼病好发于中老年男性，以双侧眼眶无痛性肿胀及大量IgG4⁺浆细胞浸润为特征。IgG4相关性眼病几乎可累及所有眼眶组织，尤其是泪腺。但未见特征性的闭塞性静脉炎。IgG4和IgG的免疫组化染色在鉴别IgG4相关性眼病与非IgG4相关性眼病中起重要作用。结合临床表现、实验室检查、影像学表现及组织病理学有助于诊断和鉴别诊断。（《中华眼科杂志》，2016，52：256 - 262）
