Value of serum IgG4 in the diagnosis of IgG4-related disease and in differentiation from rheumatic diseases and other diseases

被引：83

作者：

Yamamoto, Motohisa ^{[1
]}

Tabeya, Tetsuya ^{[1
]}

Naishiro, Yasuyoshi ^{[1
]}

Yajima, Hidetaka ^{[1
]}

Ishigami, Keisuke ^{[1
]}

Shimizu, Yui ^{[1
]}

Obara, Mikiko ^{[1
]}

Suzuki, Chisako ^{[1
]}

Yamashita, Kentaro ^{[1
]}

Yamamoto, Hiroyuki ^{[1
]}

Hayashi, Toshiaki ^{[1
]}

Sasaki, Shigeru ^{[1
]}

Sugaya, Toshiaki ^{[1
]}

Ishida, Tadao ^{[1
]}

Takano, Ken-ichi ^{[2
]}

Himi, Tetsuo ^{[2
]}

Suzuki, Yasuo ^{[3
]}

Nishimoto, Norihiro ^{[4
]}

Honda, Saho ^{[5
]}

Takahashi, Hiroki ^{[1
]}

Imai, Kohzoh ^{[1
,6
]}

Shinomura, Yasuhisa ^{[1
]}

机构：

[1] Sapporo Med Univ, Sch Med, Dept Internal Med 1, Chuo Ku, Sapporo, Hokkaido 0608543, Japan

[2] Sapporo Med Univ, Sch Med, Dept Otolaryngol, Sapporo, Hokkaido 0608543, Japan

[3] Teine Keijinkai Hosp, Dept Ophthalmol, Sapporo, Hokkaido, Japan

[4] Wakayama Med Univ, Lab Immune Regulat, Osaka, Japan

[5] JR Sapporo Hosp, Dept Internal Med & Rheumatol, Sapporo, Hokkaido, Japan

[6] Univ Tokyo, Inst Med Sci, Adv Clin Res Ctr, Tokyo, Japan

来源：

MODERN RHEUMATOLOGY | 2012年 / 22卷 / 03期

关键词：

Autoimmune pancreatitis; Churg-Strauss syndrome; IgG4; Mikulicz's disease; Rheumatoid arthritis; COLLEGE-OF-RHEUMATOLOGY; SKIN THICKNESS SCORE; AUTOIMMUNE PANCREATITIS; AMERICAN-COLLEGE; CLASSIFICATION CRITERIA; SUBCLASS CONCENTRATIONS; SYSTEMIC-SCLEROSIS; MIKULICZS-DISEASE; SJOGRENS-SYNDROME; LIVER-DISEASE;

D O I：

10.1007/s10165-011-0532-6

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IgG4-related disease (IgG4-RD) is a novel disease entity that includes Mikulicz's disease, autoimmune pancreatitis (AIP), and many other conditions. It is characterized by elevated serum IgG4 levels and abundant IgG4-bearing plasmacyte infiltration of involved organs. We postulated that high levels of serum IgG4 would comprise a useful diagnostic tool, but little information is available about IgG4 in conditions other than IgG4-RD, including rheumatic diseases. Several reports have described cutoff values for serum IgG4 when diagnosing IgG4-RD, but these studies mostly used 135 mg/dL in AIP to differentiate from pancreatic cancer instead of rheumatic and other common diseases. There is no evidence for a cutoff serum IgG4 level of 135 mg/dL for rheumatic diseases and common diseases that are often complicated with rheumatic diseases. The aim of this work was to re-evaluate the usual cutoff serum IgG4 value in AIP (135 mg/dL) that is used to diagnose whole IgG4-RD in the setting of a rheumatic clinic by measuring serum IgG4 levels in IgG4-RD and various disorders. We therefore constructed ROC curves of serum IgG4 levels in 418 patients who attended Sapporo Medical University Hospital due to IgG4-RD and various rheumatic and common disorders. The optimal cut-off value of serum IgG4 for a diagnosis of IgG4-RD was 144 mg/dL, and the sensitivity and specificity were 95.10 and 90.76%, respectively. Levels of serum IgG4 were elevated in IgG4-RD, Churg-Strauss syndrome, multicentric Castleman's disease, eosinophilic disorders, and in some patients with rheumatoid arthritis, systemic sclerosis, chronic hepatitis, and liver cirrhosis. The usual cut-off value of 135 mg/dL in AIP is useful for diagnosing whole IgG4-RD, but high levels of serum IgG4 are sometimes observed in not only IgG4-RD but also other rheumatic and common diseases.

引用

页码：419 / 425

页数：7

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