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Relationship between Serum IgG4 Level and CT Morphological Changes of Abdominal Organs Involved in Autoimmune Pancreatitis Patients
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摘要:
目的 探讨自身免疫性胰腺炎(autoimmune pancreatitis, AIP)患者血清IgG4水平变化与腹部受累器官CT形态变化的关系。 方法 回顾性分析19例临床诊断为AIP且相关资料完整患者的血清IgG4水平、胰腺及腹部胰外受累器官CT形态变化, 并分别根据其变化趋势将患者区分为好转与无好转, 用Fisher确切概率法分析血清IgG4水平变化趋势、胰腺形态变化趋势与腹部胰外受累器官形态变化趋势三者之间的一致性。 结果 血清IgG4水平变化与胰腺形态变化趋势一致者13例, 不一致者6例, 一致性检验P=0.169;血清IgG4水平变化与腹部胰外受累器官形态变化趋势一致者15例, 不一致者4例, 一致性检验P=0.013;胰腺与腹部胰外受累器官形态变化趋势一致者15例, 不一致者4例, 一致性检验P=0.020。 结论 血清IgG4水平与腹部胰外受累器官形态变化趋势、胰腺与腹部胰外受累器官形态变化趋势一致性较好, 血清IgG4水平与胰腺形态变化趋势一致性差。 Abstract:Objective To evaluate the relationship between serum IgG4 levels and CT morphological changes of abdominal organs involved in autoimmune pancreatitis (AIP). Methods Serum IgG4 levels, pancreas and other involved abdominal extrapancreatic organs' CT morphological changes of 19 clinically diagnosed AIP patients who had complete related information were retrospectively analyzed. The patients were divided into two groups (recovering and non-recovering) according to the above three aspects. Consistency among serum IgG4 levels, morphological changes of the pancreas and morphological changes of involved abdominal extrapancreatic organs was evaluated by Fisher exact test. Results In total, 13/19 patients had consistent trend between serum IgG4 level and pancreatic morphological changes (P=0.169); 15/19 had consistent trend between serum IgG4 level and morphological changes of involved abdominal extrapancreatic organs (P=0.013); 15/19 patients had consistent trend in morphological changes between the pancreas and involved abdominal extrapancreatic organs (P=0.020). Conclusions The trend of serum IgG4 level and morphological changes of involved abdominal extrapancreatic organs have a good consistency, so do the morphological changes of the pancreas and involved abdominal extrapancreatic organs, while the trend of serum IgG4 level appears to have a poor consistency with the morphological changes of the pancreas. -
Key words:
- autoimmune pancreatitis /
- computed tomography /
- serum IgG4 level
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图 2 46岁女性自身免疫性胰腺炎患者CT图像
A.确诊自身免疫性胰腺炎时胰腺肿胀，伴低密度包壳，血清IgG4水平为5930 mg/L；B.13个月后，胰腺肿胀程度减轻，周围低密度包壳消失，血清IgG4水平为1260 mg/L，IgG4水平变化与胰腺形态变化趋势一致
图 3 69岁男性自身免疫性胰腺炎患者CT图像
A.确诊自身免疫性胰腺炎时胰腺肿胀，伴低密度包壳，血清IgG4水平为20 600 mg/L；B.2个月后，胰腺形态恢复正常，周围低密度包壳消失，血清IgG4水平为21 900 mg/L，IgG4水平变化与胰腺形态变化趋势不一致
图 4 56岁男性自身免疫性胰腺炎患者CT图像
A.确诊自身免疫性胰腺炎时肾脏实质密度均匀，未见明显病灶，血清IgG4水平为2930 mg/L；B.16个月后，肾脏实质内多发片状低密度影，血清IgG4水平为6360 mg/L，IgG4水平变化与胰外受累器官形态变化趋势一致
图 5 48岁男性自身免疫性胰腺炎患者CT图像
A.确诊自身免疫性胰腺炎时胆总管管径约为12 mm，胆管壁增厚伴强化，血清IgG4水平为801 mg/L；B.22个月后，胆总管管径约为9.5 mm，胆管壁未见明显增厚，血清IgG4水平为8140 mg/L，IgG4水平变化与胰外受累器官形态变化趋势不一致
表 1 自身免疫性胰腺炎患者受累器官形态变化与IgG4水平变化趋势的一致性(例)
指标 一致 不一致 一致性检验
P值好转 无好转 IgG4水平+胰腺形态 5 8 6 0.169 IgG4水平+胰外受累器官形态 7 8 4 0.013 胰腺形态+胰外受累器官形态 8 7 4 0.020 
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