Torimoto Keiichi, Okada Yosuke, Kurozumi Akira, Narisawa Manabu, Arao Tadashi, Tanaka Yoshiya
First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan.
Intern Med. 2017;56(9):1009-1013. doi: 10.2169/internalmedicine.56.7824. Epub 2017 May 1.
Objective IgG4-related disease is a recently characterized condition presenting with high blood IgG4 levels, swelling of organs, and hypertrophic lesions. This disease is associated with thyroid disease, Hashimoto's disease, and Riedel's thyroiditis. However, there is little information on the association between IgG4-related disease and Basedow's disease. We herein defined the clinical features of patients with Basedow's disease and high IgG4 levels. Methods We compared two groups of patients with Basedow's disease (n=72) who had either normal IgG4 levels (<135 mg/dL; n=67) or high IgG4 levels (≥135 mg/dL; n=5 [6.9%], mean IgG4: 206±116 mg/dL, IgG4/IgG ratio: 10.6%±3.3%). Patients Seventy-two newly diagnosed, untreated patients with Basedow's disease. Results Compared to the normal IgG4 group, patients in the high IgG4 group were predominantly male and showed a significantly higher thyroid low-echo score (1.8±0.4 vs. 1.2±0.5) and eosinophil count (363±354/mm vs. 136±122/mm). Five patients had high IgG4 levels: one had a pancreatic lesion, and four had thyroid lesions. Conclusion Patients with Basedow's disease and high IgG4 levels may represent a new subtype of Basedow's disease. Further studies with larger sample sizes are needed.
目的 IgG4 相关疾病是一种最近才被明确特征的病症，表现为血液中 IgG4 水平升高、器官肿胀和肥厚性病变。这种疾病与甲状腺疾病、桥本氏病和 Riedel 甲状腺炎相关。然而，关于 IgG4 相关疾病与格雷夫斯病之间的关联信息很少。我们在此定义了格雷夫斯病且 IgG4 水平高的患者的临床特征。方法 我们比较了两组格雷夫斯病患者（n = 72），一组 IgG4 水平正常（<135 mg/dL；n = 67），另一组 IgG4 水平高（≥135 mg/dL；n = 5 [6.9%]，平均 IgG4：206±116 mg/dL，IgG4/IgG 比值：10.6%±3.3%）。患者 72 例新诊断的、未经治疗的格雷夫斯病患者。结果 与 IgG4 水平正常组相比，IgG4 水平高的组患者以男性为主，甲状腺低回声评分显著更高（1.8±0.4 对 1.2±0.5），嗜酸性粒细胞计数也更高（363±354/mm 对 136±122/mm）。5 例患者 IgG4 水平高：1 例有胰腺病变，4 例有甲状腺病变。结论 格雷夫斯病且 IgG4 水平高的患者可能代表格雷夫斯病的一种新亚型。需要更大样本量的进一步研究。
