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测量胆汁中的IgG4:一项新的IgG4相关的胆管疾病的诊断方法

发布日期:2014-1-29 12:40:36 文章来源:Endoscopy 作者次数:1114
    测量胆汁中的IgG4:一项新的IgG4相关的胆管疾病的诊断方法

    K. Vosskuhl1, A. A. Negm1, T. Framke2, T. Weismüller1, 3, M. P. Manns1, H. Wedemeyer1, 3, R. R. Plentz1, J. Wedemeyer1, 3, *, T. O. Lankisch1, 3, *

    1德国汉诺威医学院消化、肝病和内分泌科

    2德国汉诺威医学院生物统计系

    3德国汉诺威医学院综合研究和治疗中心---移植(IFB-Tx

    背景和研究目的:因为胆管造影不能将相关的胆道狭窄与胆管癌原发性硬化性胆管炎PSC)区分开,因此免疫球蛋白G4IgG4相关的胆管炎IAC)是很难诊断的。血清中免疫球蛋白G4水平不仅显示的灵敏度和特异性较低,而且不可靠,特别是对如原发性硬化性胆管炎等有关疾病的患者更甚。当免疫球蛋白G4相关的胆管炎发生于胆管上皮细胞时,我们推测测量胆汁中IgG4比测量血清中的IgG4可能会有着更高的灵敏度。

    方法:胆管造影期间采集67例患者的胆汁和血清标本,这些患者包括23例原发性硬化性胆管炎患者,25例胆管癌患者,14胆总管结石病患者以及5IgG4相关的胆管炎患者。分别测量胆汁与血清中的IgG4水平。

    结果:免疫球蛋白G4相关的胆管炎患者胆汁中IgG4水平明显高于其他胆道疾病患者。然而研究发现原发性硬化性胆管炎患者与免疫球蛋白G4相关的胆管炎患者的血清中IgG4水平均升高,但是胆汁中的IgG4水平升高仅出现在免疫球蛋白G4相关的胆管炎患者中。

    结论:研究表明测量胆汁中IgG4水平是可接受的,而且它可能有助于区分免疫球蛋白G4相关的胆管炎和其它疾病

     

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    Measurement of IgG4 inbile: a new approach for the diagnosis of IgG4-associated cholangiopathy

    K. Vosskuhl1, A. A. Negm1, T. Framke2, T. Weismüller1, 3, M. P. Manns1, H. Wedemeyer1, 3, R. R. Plentz1, J. Wedemeyer1, 3, *, T. O. Lankisch1, 3, *

    1Department of Gastroenterology, Hepatology, and Endocrinology,HannoverMedicalSchool,Hannover,Germany

    2Department of Biostatistics,HannoverMedicalSchool,Hannover,Germany

    3Integrated Research andTreatmentCenter- Transplantation (IFB-Tx),HannoverMedicalSchool,Hannover,Germany

    Background and study aims: Immunoglobulin G4 (IgG4)-associated cholangitis (IAC) is difficult to diagnose because on cholangiography the associated biliary tract strictures cannot be differentiated from cholangiocarcinoma or primary sclerosing cholangitis (PSC). Serum IgG4 levels show a low sensitivity and specificity and are unreliable, particularly in patients with related diseases such as PSC. As IAC takes place at the biliary epithelium, we hypothesized that IgG4 measurement in bile may have higher sensitivity compared with serum.

    Methods: Bile and serum samples were collected during cholangiography in 67 patients, including 23 patients with PSC, 25 with cholangiocarcinoma, 14 with choledocholithiasis, and five with IAC. IgG4 was measured in both bile and serum.

    Results: Bile IgG4 levels were markedly elevated in patients with IAC compared with patients with other biliary disorders. Whereas elevated serum IgG4 levels were found both in patients with PSC and IAC, biliary IgG4 levels were only increased in patients with IAC.

    Conclusions: The study demonstrates that bile IgG4 measurement is possible and may help to distinguish IAC from other diseases.

     

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