title: Clinical and pathological differences between serum immunoglobulin G4-positive and -negative type 1 autoimmune pancreatitis.
abstract: OBJECTIVE
  To identify clinical and pathological differences between serum immunoglobulin G4 (IgG4)-positive (SIP) and IgG4-negative (SIN) type 1 autoimmune pancreatitis (AIP) in South Korea.
  
  
  METHODS
  AIP was diagnosed by the international consensus diagnostic criteria. The medical records and pathology were retrospectively reviewed and IgG4-positive cells were counted in a high power field (HPF). Type I AIP was defined as a high serum level of IgG4 or histological finding. SIN type 1 AIP was defined as a histological evidence of type 1 AIP and a normal serum IgG4 level. The clinical and pathological findings were compared between the two groups. The analysis was performed using Student's t test, Fischer's exact test and Mann-Whitney's U test. A P value of < 0.05 was considered statistically significant. As repeated comparison was made, P values of less than 5% (P < 0.05) were considered significant.
  
  
  RESULTS
  Twenty five patients with definite type 1 AIP (19 histologically and six serologically diagnosed cases) were enrolled. The mean tissue IgG4 concentrations were significantly higher in SIP than SIN group (40 cells per HPF vs 18 cells per HPF, P = 0.02). Among eight SIN patients, the tissue IgG4 concentrations were less than 15 cells per HPF in most of cases, except one. The sensitivity of serum IgG4 was 68% (17 SIP and eight SIN AIP). Other organ involvement was more frequently associated with SIP than SIN AIP (59% vs 26%, P = 0.016). However, the relapse rate and diffuse swelling of the pancreas were not associated with serum IgG4 level. The concentrations of IgG4-positive cells per HPF were higher in SIP than SIN AIP (40 vs 18, P = 0.02).
  
  
  CONCLUSIONS
  The sensitivity of serum IgG4 was 68% in type 1 AIP. High serum IgG4 level was associated with other organ involvement and tissue IgG4 concentration but did not affect the relapse rate in type 1 AIP.
authors.affiliation: Department of Internal Medicine, Liver Research Institute, Seoul 110-744, South Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Paik
authors.forename: Ji Kon
authors.initials: JK
authors.lastname: Ryu
authors.forename: Jin Myung
authors.initials: JM
authors.lastname: Park
authors.forename: Byeong Jun
authors.initials: BJ
authors.lastname: Song
authors.forename: Joo Kyung
authors.initials: JK
authors.lastname: Park
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Kyoungbun
authors.initials: K
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000145:classification* / Q000175:diagnosis / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010195:Pancreatitis / Q000145:classification* / Q000175:diagnosis / Q000473:pathology*; D011859:Radiography; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G
keywords: Autoimmunity; Chronic pancreatitis; Immunoglobulin G4; Immunoglobulin G4-related systemic disease; Lymphoplasmacytic sclerosing pancreatitis