摘要
目的探讨血清免疫球蛋白(Ig)G4水平和IgG4/IgG比值诊断Ⅰ型自身免疫性胰腺炎(AIP)的最佳临界值及性能。方法采用免疫散射比浊法检测47例Ⅰ型AIP患者、109例胰腺胆管恶性肿瘤患者(疾病对照组)及99名正常对照者的血清IgG亚类(IgG1、IgG2、IgG3、IgG4)水平。采用受试者工作特征(ROC)曲线评价血清IgG4水平和IgG4/IgG比值鉴别诊断Ⅰ型AIP的效能,计算曲线下面积(AUC)并确定最佳临界值。结果Ⅰ型AIP组血清IgG2、IgG4、IgG水平和IgG4/IgG比值均高于正常对照组(P<0.001);疾病对照组血清IgG1、IgG3、IgG4水平和IgG4/IgG比值均低于正常对照组(P<0.05)。Ⅰ型AIP组中血清IgG4水平升高者占95.7%,明显高于疾病对照组(3.7%)和正常对照组(2.0%)(P<0.001);疾病对照组和正常对照组之间差异无统计学意义(P>0.05)。ROC曲线分析显示,血清IgG4鉴别诊断Ⅰ型AIP的AUC为0.992,最佳临界值为1740 mg/L,敏感性、特异性和准确性分别为97.9%、96.2%和96.5%;IgG4/IgG比值鉴别诊断Ⅰ型AIP的AUC为0.988,最佳临界值为0.103,敏感性、特异性和准确性分别为97.9%、93.8%、94.5%。血清IgG4与IgG4/IgG比值鉴别诊断Ⅰ型AIP的AUC差异无统计学意义(P>0.05)。结论血清IgG4水平及IgG4/IgG比值对于诊断Ⅰ型AIP均有重要价值。
Objective To investigate the optimal cut-off value and performance of serum immunoglobulin(Ig) G4 and IgG4/IgG ratio in the diagnosis of typeⅠ autoimmune pancreatitis(AIP). Methods Serum IgG subclass (IgG1,IgG2,IgG3 and IgG4) levels in 47 patients with type Ⅰ AIP,109 patients with pancreatic cancer or cholangiocarcinoma(disease control group) and 99 healthy subjects(healthy control group) were determined by immunonephelometry. Receiver operating characteristic(ROC) curve was used to identify the optimal cut-off values and the area under curve(AUC) of serum IgG4 and IgG4/IgG ratio for the diagnosis of typeⅠ AIP. Results The levels of serum IgG2,IgG4,IgG and IgG4/IgG ratio in typeⅠ AIP group were higher than those in healthy control group(P<0.001). The levels of serum IgG1,IgG3,IgG4 and IgG4/IgG ratio in disease control group were lower than those in healthy control group(P<0.05). The proportion of elevated IgG4 level in type Ⅰ AIP group(95.7%) was higher than those in disease control group(3.7%) and healthy control group(2.0%)(P<0.001),and there was no statistical significance between disease and healthy control groups(P>0.05). The AUC of serum IgG4 for the diagnosis of typeⅠ AIP was 0.992,and the optimal cut-off value was 1 740 mg/L. The sensitivity,specificity and accuracy were 97.9%,96.2% and 96.5%. The AUC of IgG4/IgG ratio for the diagnosis of typeⅠ AIP was 0.988, the optimal cut-off value was 0.103,and the sensitivity,specificity and accuracy were 97.9%,93.8% and 94.5%. There was no statistical significance for the AUC of serum IgG4 and IgG4/IgG ratio in the diagnosis of type Ⅰ AIP(P>0.05). Conclusions Serum IgG4 level and IgG4/IgG ratio play roles in the diagnosis of typeⅠ AIP.
作者
夏长胜
樊春红
王辉
XIA Changsheng;FAN Chunhong;WANG Hui(Department of Clinical Laboratory,Peking University People's Hospital,Beijing 100044,China)
出处
《检验医学》
CAS
2019年第4期322-326,共5页
Laboratory Medicine
基金
国家发展和改革委员会资助项目(2127000068)
