Analysis Of Etiology And Clinical Characteristics Of Liver Injury With Elevated Serum IgG4 Levels

Aim:Immunoglobulin G4(IgG4)is one of the subtypes of immunoglobulin G(IgG).More and more patients in the clinic have been found to be with elevated serum IgG4 levels,some of whom are with abnormal liver function,but the relationship between liver damage and serum IgG4 remains to be elucidated.This study firstly screened the detailed clinical information of patients with elevated serum IgG4 levels from the information management center and laboratory of Tianjin Medical University General Hospital.Detailed medical records of these patients were collected from medical record room.Then we counted the proportion of patients with liver injury with elevated serum IgG4 levels,and analyzed the main etiology of patients with liver injury along with the clinical features of patients with different causes of liver injury accompanied by elevated serum IgG4 levels to determine the relationship between liver function injury and serum IgG4.Methods:157 patients with elevated serum IgG4 levels(>2.01 g/L)and complete clinical information were included in this study from the General Hospital of Tianjin Medical University from May 2012 to November 2018.The proportion of patients with liver function injury accompanied by elevated serum IgG4 levels was counted,the main etiology of patients with liver injury accompanied by elevated serum IgG4 levels and clinical features of patients with IgG4-RD,AILD,viral hepatitis,alcoholic liver disease accompanied by elevated serum IgG4 levels were analyzed as well.Result 1.Of the 157 patients with elevated serum IgG4 levels,115 had liver function injury,accounting for 73.25%.2.The etiology of liver function damage included IgG4-RD,AILD,viral hepatitis,alcoholic liver disease and malignant tumor.3.41 patients of IgG4-RD with liver injury accompanied by elevated serum IgG4 levels mainly manifested as elevated levels of GGT and DBil.There was no significant linear correlation between serum IgG4 levels and levels of ALT,AST and other indicators.32 patients were treated with hormone therapy,and 28 patients were followed up for 6 months.After hormone therapy,serum levels of several indicators of liver function and IgG4?IgE significantly decreased.4.AILD liver injury accompanied by elevated serum IgG4 levels liver function indicators were slightly elevated,ALT and AST were more pronounced.IgG4 was positively linearly correlated with ALT,and had no significant linear correlation with AST,ALKP,GGT,TBil,and DBil.9 patients were treated with hormones.Compared with that before hormone therapy,levels of ALT,ALKP,GGT significantly improved.5.5 patients of viral hepatitis with elevated serum IgG4 levels,after treatment with antiviral and hepatoprotective drugs in 2 patients,liver function returned to normal,but serum IgG4 levels were still higher.6.Two patients of alcoholic liver disease with elevated serum IgG4 levels.1 patient was treated with hormone combined with liver protection drugs,liver function and serum IgG4 levels can return to normal.But liver damage relapse after drug withdrawal,and serum IgG4 levels was not high.One case of alcoholic liver disease with elevated serum IgG4 levels developed into hepatocellular carcinoma.Conclusion 1.Patients with elevated serum IgG4 levels are often associated with liver damage with a high frequency.2.Liver damage caused by IgG4-RD,AILD,viral hepatitis,alcoholic liver disease,malignant tumors,etc.may be accompanied with elevated serum IgG4 levels.3.IgG4-RD with elevated serum IgG4 levels with liver injury often involved biliary tract and liver damage was mostly mild,with elevated GGT and DBil mainly.4.Patients of AILD liver injury with elevated serum IgG4 levels were more likely to have hepatocytes,with elevated ALT and AST,and mild liver injury.5.IgG4-RD with elevated serum IgG4 levels in patients with liver injury are sensitive to hormonal therapy.6.Elevated serum IgG4 levels in patients with viral hepatitis and alcoholic liver diseases may be concomitant.