| Background: IgG4-related disease(IgG4-related disease,IgG4-RD)has been known to people in the 20 th century.The pathogenesis of IgG4-RD is not clear at present.The epidemiological reports were only appeared in Japan.It is reported that the incidence of the disease in Japan,the proportion of male and female was 1: 0.77,the average age of onset is 58 years,the incidence rate of about 0.28-1.08 / 100 000.IgG-RD frequently affected many organs including the salivary glands and lacrimal glands,pancreas,lung,retroperitoneal space,kidneys,arachnoid,pituitary gland.The main clinical manifestations of this disease containing multisystem organ;single or multiple tissues and organs fibrosis or sclerosis;IgG4-positive there is widespread infiltration of lymphocytes(IgG4-positive plasma cells accounted for IgG-positive plasma cell ratio greater than 40%);significantly increased serum IgG4 levels(≥1.35 g /L);the treatment of glucocorticoid significantly effective.Detection of serum IgG4 convenient,fast,non-invasive,patient burden is small,and has a high sensitivity,the present study as elevating IgG4 level in serum of one way to diagnose IgG4-RD.Elevated serum IgG4 not only in IgG4-RD,but in many other clinical diseases,especially autoimmune disease for disease diagnosis as well as differential diagnosis remains to be further studied.Diagnostic threshold studies at home and abroad there are different reports.Objectives:To investigate the level of serum IgG4 common autoimmune diseases IgG4-RD and other non IgG4-RD in the differential diagnosis.Analizing IgG ratio IgG4-RD in the performance of the total serum IgG4,to explore for clinical diagnosis and differential diagnosis role of IgG4-RD can play,and initially determine its diagnostic thresholds,to provide the basis for IgG4-RD diagnosis.Methods:The samples are from patients in the First Affiliated Hospital and Second Affiliated Hospital of Dalian Medical University from February 2014 to January2016.IgG4-RD patients with IgG4-related disease in 16 cases,in which 10 males and 6females,aged 62 ± 13 years.First Affiliated Hospital of Dalian Medical University collected inpatient 280 cases of autoimmune diseases,including systemic lupus 40 patients aged 45 ± 15 years;40 cases of rheumatoid arthritis,age 61 ± 12 years;40cases of Sj?gren’s syndrome,age 59 ± 13 years;40 cases of autoimmune hepatitis,age58 ± 10 years;40 cases of ankylosing spondylitis,age 43 ± 14 years;24 cases of scleroderma,age 56 ± 12 years;35 cases of dermatomyositis age 55 ± 11 years;adult still disease in 21 cases,aged 37 ± 16 years.Select the First Affiliated Hospital of Dalian Medical University health examination center for health examination 80 cases,aged 42 ± 12 years as a control group.Siemens BNⅡ instrument for all serum samples IgG4,IgG detection,and calculate serum IgG4/IgG.Results:1.16 cases of serum IgG4 levels in patients with IgG4-RD was 14.85 ± 12.65 g / L,serum IgG was 32.81 ± 14.79 g / L,serum IgG4/IgG was 42.84 ± 25.60,were significantly higher,the difference was statistically significant(P <0.05)2.Respectively,serum IgG4≥1.35 g / L and 2.01 g / L as a critical value,the positive rate of IgG4-RD are set to 100% and the disease control group and the healthy control group sometimes positive,by chi-square test,the control group and its the difference was statistically significant(P <0.05).There is no statistically significant difference(P> 0.05)between disease control group and the healthy control group.3.Serum IgG4≥1.35 g / L as the critical value,IgG4-RD group of non-statistical sample of 18 positive cases,serum IgG4 level of 1.83 ± 0.32 g / L,serum IgG4/IgG was 8.21 ± 1.42%,and IgG4-RD group or healthy control group differences,and was statistically significant(P <0.05).4.Drawing diagnosis I serum IgG4/IgG for IgG4-RD ROC curves,whenserum IgG4/IgG = 10.76%,Youden index is the largest,the sensitivity is 93.75%,the identity is 98.33%,the area under the curve is 0.9948.Conclusions:Serum IgG4 could be as a diagnostic indicator IgG4-RD for the diagnosis and antidiastole of IgG4-RD,and other autoimmune diseases in antidiastole.The serum IgG4/IgG can be used as indicators to help diagnose,recommend serum IgG4/IgG≥10.76% as a diagnostic threshold,but due to smallsample volume,remains to be further verified a large sample size. |
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