Abstract:

Objective　To analyze serum immunoglobulin 4 (IgG4) and helper T 17 (Th17)/regulatory T cells (Treg) in the assessment of response to hormone therapy in patients with autoimmune pancreatitis (AIP). Methods　A total of 95 patients with AIP treated at Tongchuan People's Hospital from April 2021 to September 2023 were selected, including 55 males and 40 females; they were (54.28±5.51) years old; 48 cases had smoking history; 49 cases had drinking history. Before the treatment, the flow cytometry was used to detect Th17 and Treg, and Th17/Treg was calculated. The level of AMY was detected by the enzyme-linked immunosorbent assay. All the patients took hormone therapy, and were divided into an effective group (complete response and partial response) and an ineffective group (treatment failure) according to the effect. The basic data and serological indicators of the two groups were compared to analyze the influencing factors and predictive value of serum IgG4 and Th17/Treg for evaluating the efficacy of hormone therapy for the patients. t and χ² tests were used. The binary logistic stepwise regression model was used to analyze the influencing factors. The receiver operating characteristic curve (ROC) was drawn to evaluate the prediction efficacy. Results　After hormone therapy for the patients, 43 patients had complete remission, 30 partial remission, and 22 treatment failure. The effective rate was 75.00% (73/95), and the ineffective rate 23.16% (22/95). The Th17/Treg and levels of D-D, AMY, and IgG4 in the effective group were lower than those in the ineffective group [(1.05±0.14) vs. (2.21±0.34), (0.23±0.05) mg/L vs. (0.52±0.12) mg/L, (296.56±15.74) U/L vs. (436.26±18.52) U/L, and (2.47±0.41) g/L vs. (4.62±0.78) g/L], with statistical differences (t=23.475, 16.556, 35.005, and 17.091; all P<0.001). The binary logistic regression analysis results showed that the Th17/Treg (OR=4.486, 95%CI 1.533-13.125) and levels of D-D (OR=3.333, 95%CI 1.139-9.753), AMY (OR=3.912, 95%CI 1.337-11.445), and IgG4 (OR=3.077, 95%CI 1.052-9.003) were the influential factors for the efficacy of hormone therapy for the patients (all P<0.05). According to the ROC analysis, the sensitivities of Th17/Treg, D-D, AMY, IgG4, and their combination in the prediction of the ineffectiveness of hormone therapy for the patients were 77.27%, 63.64%, 68.18%, 72.73%, and 90.91%, respectively; the specificities were 76.71%, 68.49%, 69.86%, 73.97%, and 91.78%, respectively. Conclusions　Th17/Treg and the levels of D-D, AMY, and IgG4 are related to the ineffective hormone therapy for patients with AIP; the combined detection is more accurate and efficient in predicting the efficacy of hormone therapy for patients with AIP.

Key words:

IgG4, Th17/Treg, Autoimmune pancreatitis, Hormone therapy

摘要：

目的　分析血清免疫球蛋白4（immunoglobulin 4，IgG4）、辅助性T细胞17（helper T 17，Th17）/调节性T细胞（regulatory T cells，Treg）评估激素治疗自身免疫性胰腺炎（autoimmune pancreatitis，AIP）患者效果的价值。方法　选取铜川市人民医院2021年4月至2023年9月收治的95例AIP患者，其中男55例，女40例，年龄（54.28±5.51）岁；48例有吸烟史，49例有饮酒史。治疗前，用流式细胞仪检测患者Th17、Treg，计算Th17/Treg，用酶联免疫吸附法检测AMY水平。所有患者均采用激素治疗。根据疗效将患者分为有效组（完全缓解、部分缓解）和无效组（治疗失败）。对比两组患者基础资料和血清学指标。分析血清IgG4、Th17/Treg评估激素治疗AIP患者效果的价值。采用t检验和χ²检验。采用二元logistic逐步回归模型进行影响因素分析，绘制受试者操作特征曲线（ROC）评估预测效能。结果　AIP患者激素治疗后，完全缓解43例，部分缓解30例，治疗失败22例，有效率为75.00%（73/95），无效率为23.16%（22/95）。有效组Th17/Treg和D-D、AMY、IgG4水平低于无效组［（1.05±0.14）比（2.21±0.34）、（0.23±0.05）mg/L比（0.52±0.12）mg/L、（296.56±15.74）U/L比（436.26±18.52）U/L、（2.47±0.41）g/L比（4.62±0.78）g/L］，差异有统计学意义（t=23.475、16.556、35.005、17.091，均P<0.001）。二元logistic回归分析结果显示，Th17/Treg（OR=4.486，95%CI 1.533～13.125）、D-D水平（OR=3.333，95%CI 1.139～9.753）、AMY水平（OR=3.912，95%CI 1.337～11.445）、IgG4水平（OR=3.077，95%CI 1.052～9.003）是AIP患者激素治疗无效的影响因素（均P<0.05）。ROC分析显示，Th17/Treg、D-D、AMY、IgG4、四者联合预测AIP患者激素治疗无效的灵敏度分别为77.27%、63.64%、68.18%、72.73%、90.91%，特异度分别为76.71%、68.49%、69.86%、73.97%、91.78%。结论　Th17/Treg、D-D、AMY、IgG4水平与AIP患者激素治疗无效相关，联合检测预测AIP患者激素治疗效果更为精准且高效。

关键词:

IgG4, Th17/Treg, 自身免疫性胰腺炎, 激素治疗