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血清免疫球蛋白G4相关性疾病(immunoglobulin G4-related disease,IgG4-RD)是最近才被认知的一种以器官肿胀、IgG4水平升高及IgG4阳性淋巴浆细胞的组织浸润为特征的纤维炎症性疾病。由于越来越多的研究证实这类疾病是全身系统性疾病,因此在2003年首次引入了“IgG4系统性疾病”的概念[1],并将这类疾病总称为IgG4-RD[2]。该疾病可累及全身所有器官,并且各个受累器官的组织病理学和免疫组化特征基本一致。其中最早被认识,也是最常见的“自身免疫性胰腺炎”于2001年以“IgG4水平升高的硬化性胰腺炎(autoimmune pancreatitis,AIP)”被最先报道[3]。
PET/CT作为一种全身检查现已广泛应用于临床,尤其在以淋巴瘤为代表的累及多部位、多器官疾病的应用中已经取得了成功的经验。又因IgG4-RD具有系统性疾病的特点,PET/CT在该疾病的分期、引导活检及疗效监控等方面可能具有广阔的应用前景。本文就近年来PET/CT在IgG4-RD中的应用进行综述。
免疫球蛋白G4相关性疾病的PET/CT应用
The application of PET/CT in immunoglobulin G4-related disease
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摘要: 免疫球蛋白G4(IgG4)相关性疾病是一种以器官肿胀、IgG4水平升高和IgG4阳性淋巴浆细胞的组织浸润为特征的纤维炎症性疾病, 该疾病可累及多器官。PET/CT作为一种全身检查现已广泛应用于临床,特别是在以淋巴瘤为代表的累及多部位、多器官疾病的应用中已经取得了成功的经验。又因IgG4相关性疾病具有系统性疾病的特点,PET/CT在该疾病中可能具有广阔的应用前景。
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关键词:
- 免疫球蛋白G /
- 免疫球蛋白G4相关性疾病 /
- 自身免疫性胰腺炎 /
- 正电子发射断层显像术
Abstract: Immunoglobulin G4(IgG4)-related disease is a kind of new systemic entity characterized by mass-forming lesions in various organs that consist of lymphoplasmacytic infiltrates and fibrosclerosis with numerous IgG4-positive plasma cells. PET/CT has been widely used in clinical as a whole body examination that earned plenty of successful experience, especially in multiple locations and organs cancer such as lymphoma. PET/CT also has a potential application in IgG4-related diseases as its feature of systemic. -
[1] Kamisawa T, Egawa N, Nakajima H. Autoimmune pancreatitis is a systemic autoimmune disease. Am J Gastroenterol, 2003, 98(12): 2811-2812. [2] Umehara H, Okazaki K, Masaki Y, et al. A novel clinical entity, IgG4-related disease(IgG4RD): general concept and details. Mod Rheumatol, 2012, 22(1): 1-14. [3] Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med, 2001, 344(10): 732-738. [4] Ebbo M, Grados A, Bernit E, et al. Pathologies Associated with Serum IgG4 Elevation[J/OL]. Int J Rheumatol, 2012[2012-08-26].http://www.ncbi.nlm.nih.gov/pubmed/22966232. [5] Okazaki K, Kawa S, Kamisawa T, et al. Japanese consensus guidelines for management of autoimmune pancreatitis: Ⅰ. Concept and diagnosis of autoimmune pancreatitis. J Gastroenterol, 2010, 45(3): 249-265. doi: 10.1007/s00535-009-0184-x [6] Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol, 2006, 4(8): 1010-1016; quiz 1934. [7] Nakajo M, Jinnouchi S, Fukukura Y, et al. The efficacy of whole-body FDG-PET or PET/CT for autoimmune pancreatitis and associated extrapancreatic autoimmune lesions. Eur J Nucl Med Mol Imaging, 2007, 34(12): 2088-2095. [8] Ozaki Y, Oguchi K, Hamano H, et al. Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography. J Gastroenterol, 2008, 43(2): 144-151. [9] Saeki T, Nishi S, Imai N, et al. Clinicopathological characteristics of patients with IgG4-related tubulointerstitial nephritis. Kidney Int, 2010, 78(10): 1016-1023. [10] Masaki Y, Dong L, Kurose N, et al. Proposal for a new clinical entity, IgG4-positive multiorgan lymphoproliferative syndrome: analysis of 64 cases of IgG4-related disorders. Ann Rheum Dis, 2009, 68(8): 1310-1315. [11] Takahashi N, Ghazale AH, Smyrk TC, et al. Possible association between IgG4-associated systemic disease with or without autoimmune pancreatitis and non-Hodgkin lymphoma. Pancreas, 2009, 38(5): 523-526. [12] Kamisawa T, Okazaki K, Kawa S, et al. Japanese consensus guidelines for management of autoimmune pancreatitis: Ⅲ. Treatment and prognosis of AIP. J Gastroenterol, 2010, 45(5): 471-477. doi: 10.1007/s00535-009-0197-5 [13] Matsubayashi H, Furukawa H, Maeda A, et al. Usefulness of positron emission tomography in the evaluation of distribution and activity of systemic lesions associated with autoimmune pancreatitis. Pancreatology, 2009, 9(5): 694-699. [14] Tanaka A, Moriyama M, Nakashima H, et al. Th2 and regulatory immune reactions contribute to IgG4 production and the initiation of Mikulicz disease. Arthritis Rheum, 2012, 64(1): 254-263. [15] Suga K, Kawakami Y, Hiyama A, et al. F-18 FDG PET-CT findings in Mikulicz disease and systemic involvement of IgG4-related lesions. Clin Nucl Med, 2009, 34(3):164-167. [16] Radu CG, Shu CJ, Nair-Gill E, et al. Molecular imaging of lymphoid organs and immune activation by positron emission tomography with a new [18F]-labeled 2'-deoxycytidine analog. Nat Med, 2008, 14(7): 783-788. doi: 10.1007/s10553-008-0021-6
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