IgG4与风湿免疫性疾病

近年来，随着对IgG4分子的逐步认识，其临床意义也得到了关注和重视。目前临床工作中发现IgG4水平不仅对IgG4相关性疾病(IgG4-related disease，IgG4-RD)诊断有重要价值，部分风湿免疫性疾病患者也存在IgG4水平的异常。本文主要就IgG4分子生物学特点及与风湿免疫性疾病相关性作一综述。

IgG4相关腹膜后纤维化1例

患者,男,51岁,汉族,因间歇性腹泻2年余于2015-03-07入我院.入院前间断服用“黄连素”治疗3个月,效果不佳.入院查体未见明显阳性体征.辅助检查:丙氨酸氨基转移酶165 IU/L,天门冬氨酸转氨酶57 IU/L,碱性磷酸酶127 IU/L,γ-谷氨酰基转移酶275 IU/L.IgG4水平1 520～2 121 mg/dl(＜1350).C反应蛋白1.270 mg/dl,血沉31 mm/h.上腹部增强CT示:腹腔干及其分支、肠系膜上下动脉及其分支周围可见低密度影环绕,局部呈包裹性,考虑腹膜后纤维化.超声胃镜下介入诊疗胰体部见一低回声肿块,大小约2.6 cm×1.3 cm,边界不清,回声不均匀.

哮喘患儿血清免疫指标分析

目的 以哮喘患儿为研究对象,观察分析哮喘患儿急性发作期和疾病缓解期血清总IgE、IL-4、IFN-γ、IgG4的临床免疫学指标与哮喘发作的相关性,并探讨哮喘患儿发生的免疫学机制.方法 选取30例哮喘患儿为病例组,同时选择30例入托前3～4岁门诊体检儿童为健康对照组.采用免疫散射比浊法检测哮喘患儿急性发作期和缓解期血清总IgE、IgG4的水平,运用酶联免疫吸附实验(ELISA)检测其IL-4和IFN-γ的水平.结果 病例组急性期血清总IgE、IL-4、IgG4水平均明显高于缓解期(P＜0.05),而IFN-γ水平显著低于缓解期(P＜0.05);病例组缓解期血清总IgE、IL-4水平明显高于健康对照组(P＜0.05),IFN-γ水平明显低于健康对照组(P＜0.05);病例组缓解期IgG4水平和健康对照组比较,差异无统计学意义(P＞0.05).病例组急性发作期IL-4与总IgE呈正相关性(r=0.751 7).结论 检测血清总IgE、IL-4、IFN-γ和IgG4的水平可辅助诊断儿童哮喘;监测血清总IgE、IL-4、IFN-γ、IgG4水平可进行疗效判断.

Pancreatic fat accumulation has been described with various terms including pancreatic lipomatosis, pancre-atic steatosis, fatty replacement, fatty infiltration, fatty pan-creas, lipomatous pseudohypertrophy and nonalcoholic fatty pancreas disease. It has been reported to be associated with type 2 diabetes mellitus, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula. The real incidence of this condition is still unknown. We report a case of pancreatic steatosis in a non-obese female patient initially diagnosed with a mass in the head of the pancreas. Magnetic resonance imaging (MRI) was carried out to define the characteristics of the pancreatic mass. MRI confirmed the diagnosis of fat pan-creas. Enlarged pancreas is not always a cancer, but pancreatic steatosis is characterized by pancreatic enlargement. MRI could give a definite diagnosis of pancreatic steatosis or cancer.