Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level: A single-center, retrospective cohort study

doi:10.3748/wjg.v29.i35.5125

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastroenterol. Sep 21, 2023; 29(35): 5125-5137
Published online Sep 21, 2023. doi: 10.3748/wjg.v29.i35.5125

Table 1 Demographic characteristics of patients in the two groups

	Normal group (n = 65)	Abnormal group (n = 148)	P value
Male (n, %)	49 (75.4)	116 (78.4)	0.722
Ratio (men to women)	3.06	3.63	0.722
Age (yr)	57.4 ± 12.6	59.8 ± 11.0	0.163
Age of men	56.5 ± 12.9	60.3 ± 10.4	0.047^a
Age of women	60.1 ± 11.8	57.94 ± 12.9	0.572
Duration before diagnosis (d)	78.4 ± 71.7	93.1 ± 124.8	0.686
Lengths of stay (d)	16.5 ± 8.7	15.6 ± 9.0	0.351

^aP < 0.05 vs normal group.

Table 2 Clinical symptoms of patients in the two groups (n, %)

	Normal group (n = 65)	Abnormal group (n = 148)	P value
Inducements
No obvious cause	56 (86.2)	125 (84.5)	0.750
Greasy food intake	7 (10.8)	16 (10.8)	0.993
Alcohol intake	2 (3.1)	5 (3.4)	0.910
Initial symptoms
Abdominal pain	24 (36.9)	63 (42.6)	0.440
Jaundice	20 (30.8)	42 (28.4)	0.724
Abdominal distension	11 (16.9)	31 (20.9)	0.497
Pruritus	6 (9.2)	22 (14.9)	0.263
Diarrhea	0 (0.0)	7 (4.7)	0.104
Accompanied symptoms
Jaundice	46 (70.8)	86 (58.1)	0.080
Abdominal pain	28 (43.1)	70 (47.3)	0.569
Pruritus	15 (23.1)	37 (25.0)	0.764
Abdominal distension	11 (16.9)	34 (23.0)	0.319
Loss of weight	34 (52.3)	75 (50.7)	0.826
Extrapancreatic lesions
Sclerosing Cholangitis	20 (30.8)	55 (37.2)	0.368
Salivary and lacrimal gland	7 (10.8)	26 (17.6)	0.207
Retroperitoneal fibrosis	3 (4.6)	6 (4.1)	0.851
Kidney	4 (6.2)	10 (6.8)	0.870
Lung	1 (1.5)	2 (1.4)	0.915

Table 3 Laboratory results of patients in the two groups (n, %)

	Normal group (n = 65)	Abnormal group (n = 148)	P value
Hb (g/L)	126.3 ± 16.8	126.8 ± 14.6	0.828
WBC (× 10⁹/L)	6.5 ± 2.2	5.8 ± 1.8	0.026^a
NEUT	61.8 ± 11.1	56.1 ± 10.3	0.001^a
LY	26.8 ± 9.8	29.2 ± 8.2	0.071
EOS	3.9 ± 3.4	6.2 ± 5.4	0.001^a
BASO	0.6 ± 0.4	0.8 ± 0.5	0.003^a
PLT (× 10⁹/L)	212.9 ± 83.3	218.6 ± 75.0	0.621
TP (g/L)	67.2 ± 7.5	72.5 ± 7.9	< 0.001^a
ALB (g/L)	39.4 ± 5.8	36.7 ± 4.6	0.001^a
TT (s)	16.9 ± 1.2	17.4 ± 1.6	0.012^a
IgG1 (mg/dL)	872.6 ± 371.8	935.8 ± 319.9	0.045^a
IgG2 (mg/dL)	450.4 ± 174.0	638.6 ± 241.6	< 0.001^a
IgG3 (mg/dL)	42.70 ± 43.37	53.6 ± 58.4	0.034^a
IgG4 (mg/dL)	252.7 ± 106.6	1420.5 ± 1110.9	< 0.001^a
IgE (IU/mL)	231.7 ± 352.5	635.6 ± 958.1	0.002^a
IgG (mg/dL)	1323.6 ± 503.9	2062.1 ± 918.9	< 0.001^a
FLC-κ (mg/dL)	306.1 ± 99.7	569.6 ± 252.5	< 0.001^a
FLC-λ (mg/dL)	176.4 ± 63.4	282.5 ± 124.5	< 0.001^a
C3 (mg/dL)	119.0 ± 45.7	100.6 ± 36.2	0.050
ESR (mm/h)	21.1 ± 20.1	43.4 ± 28.6	0.002^a
ANA (positive)	5 (12.5)	19 (20.0)	0.298
CA19-9 (abnormal)	33 (53.0)	73 (52.0)	0.887

^aP < 0.05 vs normal group. Hb: Hemoglobin; WBC: White blood cell; NEUT: Neutrophil; LY: Lymphocyte; EOS: Eosinophil; PLT: Hemoglobin; BASO: Basophil; TP: Total protein; ALB: Albumin; TT: Thrombin time; FLC: Free light chain; ANA: Antinuclear antibody; CA19-9: Carbohydrate associated antigen 19-9; Ig: Immunoglobulin; C3: Complement C3; ESR: Erythrocyte sedimentation rate.

Table 4 Radiological results of patients in the two groups (n, %)

	Normal group (n = 65)	Abnormal group (n = 127)	P value
Parenchymal imaging
Diffuse type	33 (56.9)	86 (67.7)	0.154
Focal type	16 (27.6)	24 (18.9)	0.227
Normal	9 (15.5)	17 (13.4)	0.699
Capsule-like rim	10 (17.2)	30 (23.6)	0.328
Others
Bile duct enhancement	15 (25.9)	44 (34.7)	0.234
Hypo-dense lesion in kidney	4 (6.9)	11 (8.7)	0.683
Pancreatic atrophy	5 (8.6)	2 (1.6)	0.020^a
Retroperitoneal fibrosis	3 (5.2)	1 (0.8)	0.057
Pancreatic pseudocyst	1 (1.7)	3 (2.4)	0.782
Pancreatic ductal imaging
Stricture or dilatation	22 (37.9)	30 (23.6)	0.045^a
Normal	36 (62.1)	97 (76.4)
SUV-max	4.55 (3.725-6.25)	5.35 (4.025-6.475)	0.260

^aP < 0.05 vs normal group. SUV-max: Maximum standard uptake value.

Table 5 Remission and relapse of patients in the two groups (n, %)

	Normal group (n = 65)	Abnormal group (n = 148)	P value
Managements
Methods
Steroid monotherapy	26 (40.0)	81 (54.7)	0.029^a
Steroid and immunomodulator	14 (21.5)	30 (20.3)
Endoscope or surgery	12 (18.5)	9 (6.1)
Others¹	13 (20.0)	28 (18.9)
Duration of steroid (wk)	8 (6-9)	8 (6-9)	0.750
Dose of steroid (prednisolone, mg/d)	42.5 (40-100)	40 (30-50)	0.200
Remission	65 (100.0)	145 (98.0)	0.555
	Normal group (n = 4)	Abnormal group (n = 26)	P value
Relapse
Relapse rate	4/58 (6.2)	26/135 (17.6)	0.030^a
Relapse duration (mo)	25 (13.5-52.3)	43 (16.3-72)	0.442
Lesions of relapse
Pancreas	4 (100.0)	21 (80.8)	0.337
Extrapancreatic organs	0 (0.0)	5 (19.2)	0.337
Times of relapse
Once	4 (100.0)	22 (84.6)	0.399
More than one time	0 (0.0)	4 (15.4)	0.399
Initial therapies
Steroid monotherapy	1 (25.0)	15 (57.7)	0.129
Steroid and immunomodulator	2 (50.0)	2 (7.70)
Endoscope or surgery	0 (0.00)	2 (7.70)
Others¹	1 (25.0)	7 (26.9)
Therapies for relapse
Steroid monotherapy	2 (50.0)	18 (69.2)	0.410
Steroid and immunomodulator	1 (25.0)	2 (7.70)
Endoscope or surgery	1 (25.0)	2 (7.70)
Others¹	0 (0.00)	4 (15.4)

^aP < 0.05 vs normal group.

¹Others: Hepatic protectors, antibiotics and proton pump inhibitors.

Citation: Zhou GZ, Zeng JQ, Wang L, Liu M, Meng K, Wang ZK, Zhang XL, Peng LH, Yan B, Pan F. Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level: A single-center, retrospective cohort study. World J Gastroenterol 2023; 29(35): 5125-5137
URL: https://www.wjgnet.com/1007-9327/full/v29/i35/5125.htm
DOI: https://dx.doi.org/10.3748/wjg.v29.i35.5125