Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.
Department of Gastroenterology, School of Medicine, Kochi University, Kochi, Japan.
Pancreatology. 2021 Apr;21(3):658-665. doi: 10.1016/j.pan.2021.03.001. Epub 2021 Mar 6.
/Object: Some patients with type 1 autoimmune pancreatitis (AIP), the pancreatic manifestation of IgG4-related disease, have normal serum IgG4. The aim of this study is to investigate the diagnostic value of measuring serum free light chains (FLCs) in type 1 AIP.
Thirty-seven patients with type 1 AIP, and 21 healthy, 17 alcoholic chronic pancreatitis (ACP), 21 idiopathic chronic pancreatitis (ICP) and 20 pancreatic cancer (PC) patients were enrolled. Serum IgG4 and FLC concentrations were measured using sFLC Freelite assays on a nephelometric analyzer.
Active AIP patients have significantly higher serum levels of κ (median 30.97 (12.3-227.0) mg/L) and λFLC (median 20.53 (12.36-102.7) mg/L)) than healthy controls (κFLC; median 12.5 (3.1-52.1) mg/L), λFLC: median 12.45 (5.4-39.5) mg/L) (p < 0.05) correlating with raised serum IgG4, and significantly higher summated FLCs (∑) (median 53.09 (25.0-218.0) mg/L) than ICP patients (median 26.77 (15.0-89.2) mg/L) and healthy controls (median 24.43 (8.5-91.6) mg/L) (p < 0.05). AIP patients (median 1.43 (0.84-3.24)) showed significantly higher κ/λ ratios than ACP (median 0.83 (0.42-1.18)), ICP (median 0.87 (0.47-2.16)), PC patients (median 0.90 (0.48-1.27)) and healthy controls (median 0.963 (0.51-1.32)). There was a correlation between increased κ and λ FLCs levels and the number of affected organs involved in IgG4 related disease.
Patients with type 1 AIP have increased serum k and λ FLC concentrations, Σ FLC, and κ/λ ratios. These novel biomarkers may be useful in the diagnosis of type 1 AIP and in monitoring disease activity.
目的：一些 1 型自身免疫性胰腺炎（AIP）患者，即 IgG4 相关疾病的胰腺表现，血清 IgG4 正常。本研究旨在探讨测定 1 型 AIP 患者血清游离轻链（FLC）的诊断价值。
纳入 37 例 1 型 AIP 患者、21 名健康对照者、17 例酒精性慢性胰腺炎（ACP）患者、21 例特发性慢性胰腺炎（ICP）患者和 20 例胰腺癌（PC）患者。采用散射比浊法在 nephelometric 分析仪上检测血清 IgG4 和 FLC 浓度。
活动期 AIP 患者的血清 κ（中位数 30.97（12.3-227.0）mg/L）和 λFLC（中位数 20.53（12.36-102.7）mg/L）水平明显高于健康对照组（κFLC：中位数 12.5（3.1-52.1）mg/L），λFLC：中位数 12.45（5.4-39.5）mg/L）（p<0.05），与升高的血清 IgG4 相关，且总和 FLCs（∑）（中位数 53.09（25.0-218.0）mg/L）明显高于 ICP 患者（中位数 26.77（15.0-89.2）mg/L）和健康对照组（中位数 24.43（8.5-91.6）mg/L）（p<0.05）。AIP 患者（中位数 1.43（0.84-3.24））的 κ/λ 比值明显高于 ACP（中位数 0.83（0.42-1.18））、ICP（中位数 0.87（0.47-2.16））、PC 患者（中位数 0.90（0.48-1.27））和健康对照组（中位数 0.963（0.51-1.32））（p<0.05）。κ 和 λ FLC 水平升高与 IgG4 相关疾病受累器官数量有关。
1 型 AIP 患者血清 κ 和 λ FLC 浓度、∑FLC 和 κ/λ 比值升高。这些新型生物标志物可能有助于 1 型 AIP 的诊断和疾病活动监测。
