IgG4相关消化系统疾病的诊断与治疗
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摘要
IgG4相关消化系统疾病是一种自身免疫反应介导的、累及多个消化器官的慢性炎症伴纤维化疾病,以血清IgG4增高及受累部位IgG4阳性浆细胞浸润为特征。由于该病临床表现、影像学及实验室检查缺乏特异性,临床上容易被误诊误治。该病对激素反应良好,但停药后易复发,再次应用激素或联合免疫调节剂、利妥昔单抗治疗是有效的。本文对该病的诊断与治疗方面进行综述。
IgG4 related digestive system disease is a chronic inflammatory and fibrotic disease mediated by autoimmune reaction,involving multiple digestive organs,characterized by elevated serum IgG4 and infiltration of IgG4 positive plasma cells in the affected area.Due to the lack of specificity of clinical manifestations,imaging and laboratory tests,it is easy to be misdiagnosed and mistreated.The disease has good response to hormones,but it is easy to relapse after withdrawal,and it is effective to use hormone or combined immunomodulator and rituximab.This review will summarize the diagnosis and treatment of the disease.
IgG4 related digestive system disease is a chronic inflammatory and fibrotic disease mediated by autoimmune reaction,involving multiple digestive organs,characterized by elevated serum IgG4 and infiltration of IgG4 positive plasma cells in the affected area.Due to the lack of specificity of clinical manifestations,imaging and laboratory tests,it is easy to be misdiagnosed and mistreated.The disease has good response to hormones,but it is easy to relapse after withdrawal,and it is effective to use hormone or combined immunomodulator and rituximab.This review will summarize the diagnosis and treatment of the disease.
引文
[1]Umehara H,Okazaki K,Masaki Y,et al.Comprehensive diagnostic criteria for Ig G4-related disease(Ig G4-RD)[J].Mod Rheumatol,2012,22(1):21-30.
[2]Umehara H,Okazaki K,Masaki Y,et al.A novel clinical entity,Ig G4-related disease(Ig G4RD):general concept and details[J].Mod Rheumatol,2012,22(1):1-14.
[3]朱晓斐,邹多武.Ig G4相关性消化疾病的研究进展[J].中华胰腺病杂志,2014,14(1):57-60.
[4]Khosroshahi A,Wallace ZS,Crowe JL,et al.International consensus guidance statement on the management and treatment of Ig G4-related disease[J].Arthritis Rheumatol,2015,67(7):1688-1699.
[5]陈雨,张文.解读首个《Ig G4相关性疾病管理和治疗的国际共识指南》[J].中华临床免疫和变态反应杂志,2015,9(3):159-162.
[6]曾冉冉,蔡顺天,孙刚,等.Ig G4相关性疾病临床特点分析[J].中国实用内科杂志,2015,35(3):242-244.
[7]方芳,李燕明,孙铭君,等.Ig G4相关疾病的临床病理学特征[J].中华病理学杂志,2014,43(9):618-622.
[8]王凤清,刘奇才,陈静,等.Ig G4相关疾病的实验室特征分析[J].胃肠病学和肝病学杂志,2014,23(11):1354-1356.
[9]《中华胰腺病杂志》编委会.我国自身免疫性胰腺炎诊治指南(草案2012,上海)[J].中华胰腺病杂志,2012,13(2):43-44.
[10]吴庆军,陈华,林玮,等.Ig G4相关自身免疫性胰腺炎的临床研究[J].中华风湿病学杂志,2012,16(12):798-802.
[11]张锐,曾弘,余先焕,等.自身免疫性胰腺炎的临床特点[J].中华肝脏外科手术学电子杂志,2014,3(3):35-37.
[12]杨彩虹,江华.自身免疫性胰腺炎临床特征及新诊断标准草案分析[J].胃肠病学和肝病学杂志,2016,25(1):94-96.
[13]章士正.Ig G4相关疾病的影像表现[J].中华放射学杂志,2014,48(11):881-885.
[14]苏里亚,高瑛,徐光,等.超声检查对自身免疫性胰腺炎的诊断价值[J].中华医学杂志,2012,92(37):2649-2651.
[15]于洪伟,刘茜伟,高宝祥,等.Ig G4相关性疾病累及腹部组织器官的影像学表现[J].医学影像学杂志,2014,24(10):1749-1752.
[16]梁璐,蒋涛,彭朋,等.Ig G4相关性疾病胸腹部CT、MRI影像表现[J].实用放射学杂志,2015,31(5):759-763.
[17]张海兵,汤敏.Ig G4相关疾病的影像特征及疗效监测[J].实用放射学杂志,2016,32(2):255-258.
[18]曹文彬,李真林,黄子星,等.CT与MRI检查对自身免疫性胰腺炎的诊断价值[J].中国普外基础与临床杂志,2014,21(6):764-768.
[19]卢青,王凯旋.自身免疫性胰腺炎的内镜诊断进展[J].中华消化内镜杂志,2012,29(7):416-417.
[20]冯菲,余仲飞,张健,等.Ig G4相关性疾病的18F-FDGPET/CT全身显像[J].医学影像学杂志,2014,24(10):1712-1715.
[21]冯云路,杨爱明,姚方,等.36例Ig G4相关硬化性胆管炎临床特点[J].协和医学杂志,2015,6(2):102-104.
[22]钟卫祥,孙柯,滕晓东.Ig G4相关性疾病临床病理学特征分析[J].临床与实验病理学杂志,2015,31(3):289-292.
[23]王宁宁,孙明军.Ig G4相关硬化性胆管炎并自身免疫性胰腺炎8例临床分析[J].山东医药,2015,55(3):43-45.
[24]Umemura T,Zen Y,Hamano H,et al.Clinical significance of immunoglobulin G4-associated autoimmune hepatitis[J].J Gastroenterol,2011,46(Suppl 1):48-55.
[25]Koyabu M,Uchida K,Miyoshi H,et al.Analysis of regulatory T cells and Ig G4-positive plasma cells among patients of Ig G4-srelated sclerosing cholangitis and autoimmune liver disease[J].J Gastroenterol,2010,45(7):732-741.
[26]Chung H,Watanabe T,Kudo M,et al.Identification and characterization of Ig G4-associated autoimmune hepatitis[J].Liver Int,2010,30(2):222-231.
[27]Shinji A,Sano K,Hamano H,et al.Autoimmune hepatitis is closely associated with gastric ulcer presenting with abundant Ig G4-bearing plasma cell infiltyation[J].Gastrointest Endosc,2004,59(4):506-511.
[28]Uehara T,Hamano H,Kawa S,et al.Chronic gastritis in the setting of autoimmune pancreatitis[J].Am J Surg Pathol,2010,34(9):1241-1249.
[29]丁辉,钱家鸣,吕红,等.自身免疫性胰腺炎激素治疗的疗效及预后研究[J].中华消化杂志,2010,30(10):721-724.
[30]杨爱明,于航.消化内镜与Ig G4相关消化系统疾病[J].医学与哲学,2016,37(3):19-22.
[2]Umehara H,Okazaki K,Masaki Y,et al.A novel clinical entity,Ig G4-related disease(Ig G4RD):general concept and details[J].Mod Rheumatol,2012,22(1):1-14.
[3]朱晓斐,邹多武.Ig G4相关性消化疾病的研究进展[J].中华胰腺病杂志,2014,14(1):57-60.
[4]Khosroshahi A,Wallace ZS,Crowe JL,et al.International consensus guidance statement on the management and treatment of Ig G4-related disease[J].Arthritis Rheumatol,2015,67(7):1688-1699.
[5]陈雨,张文.解读首个《Ig G4相关性疾病管理和治疗的国际共识指南》[J].中华临床免疫和变态反应杂志,2015,9(3):159-162.
[6]曾冉冉,蔡顺天,孙刚,等.Ig G4相关性疾病临床特点分析[J].中国实用内科杂志,2015,35(3):242-244.
[7]方芳,李燕明,孙铭君,等.Ig G4相关疾病的临床病理学特征[J].中华病理学杂志,2014,43(9):618-622.
[8]王凤清,刘奇才,陈静,等.Ig G4相关疾病的实验室特征分析[J].胃肠病学和肝病学杂志,2014,23(11):1354-1356.
[9]《中华胰腺病杂志》编委会.我国自身免疫性胰腺炎诊治指南(草案2012,上海)[J].中华胰腺病杂志,2012,13(2):43-44.
[10]吴庆军,陈华,林玮,等.Ig G4相关自身免疫性胰腺炎的临床研究[J].中华风湿病学杂志,2012,16(12):798-802.
[11]张锐,曾弘,余先焕,等.自身免疫性胰腺炎的临床特点[J].中华肝脏外科手术学电子杂志,2014,3(3):35-37.
[12]杨彩虹,江华.自身免疫性胰腺炎临床特征及新诊断标准草案分析[J].胃肠病学和肝病学杂志,2016,25(1):94-96.
[13]章士正.Ig G4相关疾病的影像表现[J].中华放射学杂志,2014,48(11):881-885.
[14]苏里亚,高瑛,徐光,等.超声检查对自身免疫性胰腺炎的诊断价值[J].中华医学杂志,2012,92(37):2649-2651.
[15]于洪伟,刘茜伟,高宝祥,等.Ig G4相关性疾病累及腹部组织器官的影像学表现[J].医学影像学杂志,2014,24(10):1749-1752.
[16]梁璐,蒋涛,彭朋,等.Ig G4相关性疾病胸腹部CT、MRI影像表现[J].实用放射学杂志,2015,31(5):759-763.
[17]张海兵,汤敏.Ig G4相关疾病的影像特征及疗效监测[J].实用放射学杂志,2016,32(2):255-258.
[18]曹文彬,李真林,黄子星,等.CT与MRI检查对自身免疫性胰腺炎的诊断价值[J].中国普外基础与临床杂志,2014,21(6):764-768.
[19]卢青,王凯旋.自身免疫性胰腺炎的内镜诊断进展[J].中华消化内镜杂志,2012,29(7):416-417.
[20]冯菲,余仲飞,张健,等.Ig G4相关性疾病的18F-FDGPET/CT全身显像[J].医学影像学杂志,2014,24(10):1712-1715.
[21]冯云路,杨爱明,姚方,等.36例Ig G4相关硬化性胆管炎临床特点[J].协和医学杂志,2015,6(2):102-104.
[22]钟卫祥,孙柯,滕晓东.Ig G4相关性疾病临床病理学特征分析[J].临床与实验病理学杂志,2015,31(3):289-292.
[23]王宁宁,孙明军.Ig G4相关硬化性胆管炎并自身免疫性胰腺炎8例临床分析[J].山东医药,2015,55(3):43-45.
[24]Umemura T,Zen Y,Hamano H,et al.Clinical significance of immunoglobulin G4-associated autoimmune hepatitis[J].J Gastroenterol,2011,46(Suppl 1):48-55.
[25]Koyabu M,Uchida K,Miyoshi H,et al.Analysis of regulatory T cells and Ig G4-positive plasma cells among patients of Ig G4-srelated sclerosing cholangitis and autoimmune liver disease[J].J Gastroenterol,2010,45(7):732-741.
[26]Chung H,Watanabe T,Kudo M,et al.Identification and characterization of Ig G4-associated autoimmune hepatitis[J].Liver Int,2010,30(2):222-231.
[27]Shinji A,Sano K,Hamano H,et al.Autoimmune hepatitis is closely associated with gastric ulcer presenting with abundant Ig G4-bearing plasma cell infiltyation[J].Gastrointest Endosc,2004,59(4):506-511.
[28]Uehara T,Hamano H,Kawa S,et al.Chronic gastritis in the setting of autoimmune pancreatitis[J].Am J Surg Pathol,2010,34(9):1241-1249.
[29]丁辉,钱家鸣,吕红,等.自身免疫性胰腺炎激素治疗的疗效及预后研究[J].中华消化杂志,2010,30(10):721-724.
[30]杨爱明,于航.消化内镜与Ig G4相关消化系统疾病[J].医学与哲学,2016,37(3):19-22.