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IgG4相关性硬化性胆管炎:肝胆胰外科医生应该重视的内科疾病

刘乔飞,  刘卫,  洪涛,  张宁,  曲强,  何小东

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文章导航 > 协和医学杂志  > 2019 >  10(3): 201-205
刘乔飞, 刘卫, 洪涛, 张宁, 曲强, 何小东. IgG4相关性硬化性胆管炎:肝胆胰外科医生应该重视的内科疾病[J]. 协和医学杂志, 2019, 10(3): 201-205. doi: 10.3969/j.issn.1674-9081.2019.03.003
引用本文: 刘乔飞, 刘卫, 洪涛, 张宁, 曲强, 何小东. IgG4相关性硬化性胆管炎:肝胆胰外科医生应该重视的内科疾病[J]. 协和医学杂志, 2019, 10(3): 201-205. doi: 10.3969/j.issn.1674-9081.2019.03.003
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Qiao-fei LIU, Wei LIU, Tao HONG, Ning ZHANG, Qiang QU, Xiao-dong HE. IgG4-related Sclerosing Cholangitis: An Internal Disease Calls for the Attention of Hepatic-biliary-pancreatic Surgeons[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(3): 201-205. doi: 10.3969/j.issn.1674-9081.2019.03.003
Citation: Qiao-fei LIU, Wei LIU, Tao HONG, Ning ZHANG, Qiang QU, Xiao-dong HE. IgG4-related Sclerosing Cholangitis: An Internal Disease Calls for the Attention of Hepatic-biliary-pancreatic Surgeons[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(3): 201-205. doi: 10.3969/j.issn.1674-9081.2019.03.003
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IgG4相关性硬化性胆管炎:肝胆胰外科医生应该重视的内科疾病

doi: 10.3969/j.issn.1674-9081.2019.03.003

  • 中国医学科学院 北京协和医学院 北京协和医院基本外科, 北京 100730

详细信息
    通讯作者:

    何小东 电话:010-69152611, E-mail:hexdpumch@sina.com

  • 中图分类号: R593.2

IgG4-related Sclerosing Cholangitis: An Internal Disease Calls for the Attention of Hepatic-biliary-pancreatic Surgeons

  • Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

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    摘要
  • 摘要: IgG4相关性疾病(IgG4-related disease, IRD)是一类近10余年逐渐被认识的以血清IgG4升高、席纹状纤维化以及大量IgG4阳性浆细胞浸润为特征的多器官和系统受累的自身免疫性疾病。胆道是IRD常受累的器官之一。IgG4相关性硬化性胆管炎(IgG4 related sclerosing cholangitis, IRSC)是IRD在胆道的临床表现形式。IRSC多有胆管壁局限性增厚、胆管扩张以及梗阻性黄疸等与胆胰恶性肿瘤相类似的临床表现。IRSC对激素敏感, 预后良好, 合并恶性肿瘤罕见, 绝大多数无需手术治疗, 但近几年笔者临床工作中仍不时见到因"胆管扩张、梗阻性黄疸"行手术治疗, 术后病理证实为IRSC的病例, 回顾这些病例的诊治过程, 鲜有术前考虑IRSC的情况。临床上也可见到术前因血清IgG4升高, 起初误诊为IRSC, 错过最佳手术时机, 而术后病理证实为胆管癌的病例。故加强对IRSC的宣讲, 特别是加深肝胆胰外科医生对IRSC的认识具有重要临床意义。
    Abstract: IgG4-related disease (IRD), a multi-organ involved autoimmune disease, has been newly defined for only about 10 years. It is characterized by elevated serum IgG4, storiform fibrosis, and massive infiltration of IgG4 positive plasma cells in involved organs. Biliary tract is one of the most commonly involved organs. IgG4-related sclerosing cholangitis (IRSC) is the clinical entity of IRD in biliary tract. It always has clinical symptoms similar to biliary-pancreatic malignancy, such as localized biliary wall thickness, dilation of the bile duct, and obstructive jaundice. IRD is sensitive to the treatment of steroids with a satisfactory prognosis and does not warrant surgical treatment. However, in recent years, we met several cases that underwent an operation due to the bile duct stricture and obstructive jaundice, yet with a final pathological report of IRSC. After reviewing these cases, we found that IRSC was seldom considered before surgery. Moreover, there were some cases of biliary malignancy with elevated serum IgG4 that were misdiagnosed to be IRSC, which led to missing the best operative time. Therefore, it is of great clinical importance to widely broadcast the knowledge of IRSC and especially to deepen the understanding of IRSC for the hepatic-biliary-pancreatic surgeons.
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    • 参考文献(29)
  • [1] Kamisawa T, Zen Y, Pillai S, et al. IgG4-related disease[J]. Lancet, 2015, 385:1460-1471. doi:  10.1016/S0140-6736(14)60720-0
    [2] Stone JH, Khosroshahi A, Deshpande V, et al. Recommendations for the nomenclature of IgG4-related disease and its individual organ system manifestations[J]. Arthritis Rheum, 2012, 64:3061-3067. doi:  10.1002/art.34593
    [3] Yoshida K, Toki F, Takeuchi T, et al. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis[J]. Dig Dis Sci, 1995, 40:1561-1568. doi:  10.1007/BF02285209
    [4] Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis[J]. N Engl J Med, 2001, 344:732-738. doi:  10.1056/NEJM200103083441005
    [5] Kamisawa T, Funata N, Hayashi Y, et al. A new clinicopathological entity of IgG4-related autoimmune disease[J]. J Gastroenterol, 2003, 38:982-984. doi:  10.1007/s00535-003-1175-y
    [6] Hirano K, Shiratori Y, Komatsu Y, et al. Involvement of the biliary system in autoimmune pancreatitis:a follow-up study[J]. Clin Gastroenterol Hepatol, 2003, 1:453-464. doi:  10.1016/S1542-3565(03)00221-0
    [7] Björnsson E, Chari ST, Smyrk TC, et al. Immunoglobulin G4 associated cholangitis:description of an emerging clinical entity based on review of the literature[J]. Hepatology, 2007, 45:1547-1554. doi:  10.1002/hep.21685
    [8] Stone JH, Zen Y, Deshpande V. IgG4-related disease[J]. N Engl J Med, 2012, 366:539-551. doi:  10.1056/NEJMra1104650
    [9] Takahashi H, Yamamoto M, Suzuki C, et al. The birthday of a new syndrome:IgG4-related diseases constitute a clinical entity[J]. Autoimmun Rev, 2010, 9:591-594. doi:  10.1016/j.autrev.2010.05.003
    [10] Deshpande V, Zen Y, Chan JK, et al. Consensus statement on the pathology of IgG4-related disease[J]. Mod Pathol, 2012, 25:1181-1192. doi:  10.1038/modpathol.2012.72
    [11] Ohara H, Okazaki K, Tsubouchi H, et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012[J]. J Hepatobiliary Pancreat Sci, 2012, 19:536-542. doi:  10.1007/s00534-012-0521-y
    [12] Khosroshahi A, Wallace ZS, Crowe JL, et al. International Consensus Guidance Statement on the Management and Treatment of IgG4-Related Disease[J]. Arthritis Rheumatol, 2015, 67:1688-1699. doi:  10.1002/art.39132
    [13] Tanaka A, Tazuma S, Okazaki K, et al. Clinical Features, Response to Treatment, and Outcomes of IgG4-Related Sclerosing Cholangitis[J]. Clin Gastroenterol Hepatol, 2017, 15:920-926 e923. doi:  10.1016/j.cgh.2016.12.038
    [14] Huggett MT, Culver EL, Kumar M, et al. Type 1 autoim-mune pancreatitis and IgG4-related sclerosing cholangitis is associated with extrapancreatic organ failure, malignancy, and mortality in a prospective UK cohort[J]. Am J Gastroenterol, 2014, 109:1675-1683. doi:  10.1038/ajg.2014.223
    [15] Tanaka A, Tazuma S, Okazaki K, et al. Nationwide survey for primary sclerosing cholangitis and IgG4-related sclerosing cholangitis in Japan[J]. J Hepatobiliary Pancreat Sci, 2014, 21:43-50. doi:  10.1002/jhbp.50
    [16] Nakazawa T, Naitoh I, Hayashi K, et al. Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification[J]. J Gastroenterol, 2012, 47:79-87. doi:  10.1007/s00535-011-0465-z
    [17] 王鹏辉, 何小东, 曹建中, 等.原发性硬化性与IgG4相关硬化性胆管炎临床特征比较[J].中华肝胆外科杂志, 2016, 22:315-319. doi:  10.3760/cma.j.issn.1007-8118.2016.05.009
    [18] Nakazawa T, Naitoh I, Hayashi K, et al. Diagnosis of IgG4-related sclerosing cholangitis[J]. World J Gastroenterol, 2013, 19:7661-7670. doi:  10.3748/wjg.v19.i43.7661
    [19] Lytras D, Kalaitzakis E, Webster GJ, et al. Cholangiocarcinoma or IgG4-associated cholangitis:how feasible it is to avoid unnecessary surgical interventions?[J]. Ann Surg, 2012, 256:1059-1067. doi:  10.1097/SLA.0b013e3182533a0a
    [20] Arikawa S, Uchida M, Kunou Y, et al. Comparison of sclerosing cholangitis with autoimmune pancreatitis and infiltra-tive extrahepatic cholangiocarcinoma:multidetector-row com-puted tomography findings[J]. Jpn J Radiol, 2010, 28:205-213. doi:  10.1007/s11604-009-0410-8
    [21] Yata M, Suzuki K, Furuhashi N, et al. Comparison of the multidetector-row computed tomography findings of IgG4-related sclerosing cholangitis and extrahepatic cholangiocarcinoma[J]. Clin Radiol, 2016, 71:203-210. doi:  10.1016/j.crad.2015.10.024
    [22] Naitoh I, Nakazawa T, Ohara H, et al. Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis[J]. J Gastroenterol, 2009, 44:1147-1155. doi:  10.1007/s00535-009-0108-9
    [23] Zhao Z, Wang Y, Guan Z, et al. Utility of FDG-PET/CT in the diagnosis of IgG4-related diseases[J]. Clin Exp Rheumatol, 2016, 34:119-125. http://europepmc.org/abstract/MED/26842851
    [24] Resheq YJ, Quaas A, von Renteln D, et al. Infiltration of peritumoural but tumour-free parenchyma with IgG4-positive plasma cells in hilar cholangiocarcinoma and pancreatic adenocarcinoma[J]. Dig Liver Dis, 2013, 45:859-865. doi:  10.1016/j.dld.2013.03.007
    [25] Liu Q, Niu Z, Li Y, et al. Immunoglobulin G4(IgG4)-positive plasma cell infiltration is associated with the clinicopathologic traits and prognosis of pancreatic cancer after curative resection[J]. Cancer Immunol Immunother, 2016, 65:931-940. doi:  10.1007/s00262-016-1853-2
    [26] Miyatani K, Saito H, Murakami Y, et al. A high number of IgG4-positive cells in gastric cancer tissue is associated with tumor progression and poor prognosis[J]. Virchows Arch, 2016, 468:549-557. doi:  10.1007/s00428-016-1914-0
    [27] Karagiannis P, Gilbert AE, Josephs DH, et al. IgG4 subclass antibodies impair antitumor immunity in melanoma[J]. J Clin Invest, 2013, 123:1457-1474. doi:  10.1172/JCI65579
    [28] Karagiannis P, Villanova F, Josephs DH, et al. Elevated IgG4 in patient circulation is associated with the risk of disease progression in melanoma[J]. Oncoimmunology, 2015, 4:e1032492. doi:  10.1080/2162402X.2015.1032492
    [29] 冯云路, 杨爱明, 姚方, 等. 36例IgG4相关硬化性胆管炎临床特点[J].协和医学杂志, 2015, 6:102-105. doi:  10.3969/j.issn.1674-9081.2015.02.005
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  • 收稿日期:  2017-08-04
  • 刊出日期:  2020-09-18

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