| BackgroundImmunoglobulin G4(IgG4)-related disease is an immune mediated condition that can affect almost any organ and now is being recognized with increasing frequency.The pathological features as follows:a dense lymphoplasmacytic infiltrate composed of IgG4~+plasma cells.It is difficult to make a differential diagnosis between IgG4-related disease and Sjorgen's syndrome because the pathological manifestations and clinical symptoms are similar to Sjorgen's syndrome when IgG4-related disease involvement of salivary glands.In recent years,there were less cases reports diagnosed with IgG4-related disease by labial gland biopsy,thus diagnose a IgG4-related disease by labial gland biopsy and make a differential diagnosis with Sjorgen's syndrome will advantageous to selection appropriate therapeutic method for patient and prognosis judgment of the patient.ObjectiveObjective to diagnose IgG4-related disease by immunohistochemical expression of IgG4 of labial gland biopsy.Make a differential diagnosis between Sjorgen's syndrome and IgG4-related disease.Further understanding the clinical and pathological features by observation the clinical data and laboratory examination.MethodAccording to the 2016 American College Rheumatology/European League Against Rheumatism classification criteria for primary Sjorgen's syndrome,and complicated with dense plasma cells infiltrate,47 cases labial gland biopsy were selected from First Affiliated Hospital of Xinxiang Medical University from 2013.01.01 to 2017.06.30.Meanwhile,we ruled out 10 cases include malignant tumor,rheumatoid arthritis,systemic lupus erythematosus and pulmonary tuberculosis,those who might affect serological test.37cases of selected cases were carried out immunohistochemical staining.We selected 7kinds of immunohistochemical antibodies:CD138?CD3?CD20?IgG?IgG4????.First,we through the immunohistochemical expression of CD138?CD3?CD20??and?ruled out plasma cell tumor and lymphoproliferative lesions.Then via the immunohistochemical expression of IgG and IgG4 make a diagnosis of IgG4-related disease,segmented 37 cases into 2 groups:the group of Sjorgen's syndrome(group A)and the group of IgG4-related disease(group B).Collect and comparative analysis the clinical data and laboratory examination of 37 cases were used to confirm the validity of the results.Result1.All of the 37 cases with dense plasma cells infiltrate positive for CD138.The ratio of?:?is 2~6:1.The B cells of 37 cases positive for CD20 expressed as focal aggregation and the T cells positive for CD3 expressed as scattered in distribution around the B cells.2.There are 12 cases positive for IgG4~+plasma cells?10/HPF and IgG4:IgG?40%in37 cases labial gland biopsy,25 cases positive for IgG4~+plasma cells?10/HPF.3.The serological test:there were 18 cases(n=20)serum anti-SSA antibody positivity in group A and have no case in group B(n=10),P<0.001.There were 15cases(n=20)serum anti-SSB antibody positivity in group A and have 3 cases in group B(n=10),P=0.07.Both of two group have 10 cases elevated serum IgG,but group A have 20cases and group B have 10 cases,P=0.36.There were 8 cases elevated serum IgG4 in group B(n=10)and have no case in group A(n=20),P<0.001.4.The clinical data:the proportion of men and women is 1:4(n=25)in group A and3:1(n=12)in group B,P<0.05.The mean age is 59.5(n=25)in group A and 62(n=12)in group B,P=0.631.There were 15 cases complaint of dry symptom in group A(n=20)and there are 3 cases in group B(n=10),P=0.74.Conclusion1.Labial gland biopsy can be used as a diagnosis method of IgG4-related disease,and the immunohistochemical expression of IgG4 of labial gland play a vital role in diagnosis of IgG4-related disease and differential diagnosis with Sjorgen's syndrome.2.The serum anti-SSA antibody and serum IgG4 test play a very important reference value in diagnosis and differential diagnosis between Sjorgen's syndrome and IgG4-related disease. |
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