头颈部IgG4相关性疾病病例报告及临床分析

发布时间：2018-06-15 14:20

本文选题：Ig + G4相关性疾病　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过总结分析本研究符合头颈部IgG4相关性疾病病理诊断的6例病例,进一步探讨头颈部IgG4相关性疾病特点、诊断与治疗,以提高耳鼻喉科医生对该病的认知程度。方法:回顾性分析就诊于吉林大学第二医院耳鼻喉科的6名IgG4-RD患者,均为通过手术切除病灶后,经病理结果回报证实为IgG4-RD。结合现有临床资料及相关文献,分析该病在头颈部的临床特征,病理学表现、血清学IgG4改变及影像学特征,总结其治疗方法。研究结果:纳入本研究的6名病理诊断符合IgG4相关性疾病的患者,分别发生于下颌下腺(4例)、泪腺(1例)、颜面部(1例)。临床表现均无显著特异性,主要表现为受累部位的无痛性局限性渐进性肿胀。该6例患者均无其他基础疾病,也无术后并发症。该6例患者中病例1、病例2术前血清学检测结果均为血清IgG4水平升高(正常范围:0.030-2.010g/l)。影像学上表现为病变区炎性改变,CT上显示病变区呈软组织密度影,MRI显示病变区呈长T1长T2信号。该6例患者均给予局麻或全麻下手术切除治疗,其中病例1手术切除后加用糖皮质激素及免疫抑制剂治疗。术后对该6例患者进行密切随访,目前尚未发现复发病例。结论:头颈部IgG4相关性疾病发病较少见,因此,亟需提高耳鼻喉科医生对该病的认知程度,从而使患者得到准确及时的治疗。诊断上,通过提高血清学IgG4水平的诊断界定值,可不同程度的提高对IgG4相关性疾病诊断的特异度。糖皮质激素仍为一线治疗药物,对于头颈部IgG4相关性疾病,若需进行手术切除治疗,则需在结合该病的影像学辅助检查结果,显示周围腺体无肿物侵袭的情况下,为减少手术损失范围,更多的保留器官功能,可行保留腺体的肿物核除术,术后再配合糖皮质激素或免疫抑制剂或生物制剂治疗(抗CD20抗体),可能会减少疾病复发的可能。
[Abstract]:Objective: to investigate the characteristics, diagnosis and treatment of IgG4-associated diseases in head and neck in 6 cases, so as to improve the recognition of IgG4 in otolaryngologists. Methods: six patients with IgG4-RD in otolaryngology department of the second Hospital of Jilin University were analyzed retrospectively. The clinical features, pathological manifestations, changes of serum IgG4 and imaging features of the disease in head and neck were analyzed based on the clinical data and related literature, and the treatment methods were summarized. Results: six patients with IgG4-associated diseases included in this study were found in 4 cases of submandibular gland, 1 case of lacrimal gland and 1 case of facial cavity. There was no significant specificity in clinical manifestations, mainly painless local progressive swelling. There were no other underlying diseases and no postoperative complications in all of the 6 patients. In case 1 of these 6 cases, the serum IgG4 level was increased in case 2 (normal range: 0.030-2.010 g / L). The imaging features were inflammatory changes in the lesion area and soft tissue density on CT. MRI showed long T 1 and long T 2 signal intensity in the lesion area. All the 6 patients were treated with local anesthesia or general anesthesia. Case 1 was treated with glucocorticoid and immunosuppressant after operation. The 6 patients were followed up closely and no recurrence cases were found. Conclusion: IgG4 related diseases in head and neck are rare, so it is urgent to improve the cognition of otolaryngologist to make the patients get accurate and timely treatment. In diagnosis, the specificity of diagnosis of IgG4 related diseases can be improved in different degree by raising the diagnostic threshold of serum IgG4 level. Glucocorticoid is still a first-line therapeutic drug. For head and neck IgG4-associated diseases, surgical excision should be performed in conjunction with the imaging findings of the disease to show that the surrounding glands are free of lesions. In order to reduce the loss of operation, preserve more organ function, preserve glandular tumor nucleus removal, and after operation with glucocorticoid or immunosuppressant or biological agent treatment (anti-CD20 antibody), may reduce the possibility of disease recurrence.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.2

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