比较免疫球蛋白(Ig)G4相关性泪腺炎和泪腺淋巴瘤患者临床特点及免疫学指标的差异性。

收集2011年6月至2019年6月于首都医科大学附属北京同仁医院眼科中心诊断为IgG4相关性泪腺炎105例(172只眼)和泪腺淋巴瘤患者39例(46只眼)的临床资料。其中，男性57例(78只眼)，女性87例(140只眼)；年龄10~89岁，平均年龄(55.3±13.6)岁。记录并统计全部患者的性别、年龄、眼别、既往病史、临床表现、影像学特征及免疫学指标等数据。年龄以±s表示，组间的比较采用独立样本t检验；性别、眼别、既往病史及临床表现以例和百分比表示，组间比较采用卡方检验和(或)Fisher确切概率法；免疫学指标符合正态分布时以±s表示，其余以中位数和上下四分位数表示，组间比较采用非参数秩和检验。

IgG4相关性泪腺炎和泪腺淋巴瘤患者中男女性别比分别为1∶2.75和2.9∶1。IgG4相关性泪腺炎患者中女性占比多于泪腺淋巴瘤者；泪腺淋巴瘤单眼发病数多于IgG4相关性泪腺炎者。两组患者性别与眼别比较的差异均有统计学意义(χ²＝27.047，25.486；P<0.05)。IgG4相关性泪腺炎患者中有术前糖皮质激素用药史者、手术史者、哮喘病史者、淋巴结肿大史者、鼻窦炎病史者及免疫系统疾病史者分别为24例、3例、4例、4例、27例及3例，分别占22.9%、2.9%、3.8%、3.8%、25.7%及2.9%。泪腺淋巴瘤患者中，则分别有9例、9例、0例、0例、5例及0例，分别占23.1%、23.1%、0、0、12.8%及0。经Fisher确切概率法检验，两组患者中有既往手术治疗史者比较的差异有统计学意义(P<0.05)；有哮喘史、淋巴结肿大史及免疫系统疾病史者比较的差异无统计学意义(P>0.05)。两组患者术前有糖皮质激素用药史和鼻窦炎史者比较的差异无统计学意义(χ²＝0.001，2.735；P>0.05)。两组患者主要临床表现为眼睑肿胀，IgG4相关性泪腺炎和泪腺淋巴瘤患者中有眼睑肿胀者分别为96例和20例，分别占91.4%和51.3%。两组患者中眼睑肿胀者比较的差异有统计学意义(χ²＝29.261，P<0.05)。两组患者影像学检查结果均显示为泪腺肿大。IgG4相关性泪腺炎和泪腺淋巴瘤患者中有泪腺肿大者分别为105例和9例，分别占100.0%和23.1%。两组患者中有泪腺肿大者比较的差异有统计学意义(χ²＝102.024，P<0.05)。IgG4相关性泪腺炎患者中补体3(C3)、补体4(C4)、类风湿因子(RF)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、C反应蛋白(CRP)、抗链球菌溶血素O(ASO)、IgG、IgG1、IgG2、IgG3及IgG4的含量分别为1002.00 (857.00，1165.45)mg/dl、204.50 (151.85，242.73)mg/dl、7.30 (2.62，12.93)mg/dl、48.50 (25.90，82.35)mg/dl、1.35 (0.61，2.56)mg/dl、2.01 (1.49，2.78 )mg/dl、0.94 (0.64，1.31)mg/dl、1480.00 (1270.00，1790.00)mg/dl、674.00 (530.00，830.50)mg/dl、534.00 (428.50，679.00)mg/dl、53.50 (26.70，78.35)mg/dl及155.00 (122.00，248.00)mg/dl。两组患者C3、C4、RF、ASO、CRP、IgA、IgG1及IgG3含量比较的差异无统计学意义(Z＝-0.040，-1.818，-0.144，-0.620，-0.699，-0.031，-1.731，-0.344；P>0.05)；两组患者IgM、IgG、IgG2及IgG4含量比较的差异有统计学意义(Z＝-3.932，-4.473，-2.821，-5.995；P<0.05)。

泪腺淋巴瘤与IgG4相关性泪腺炎患者的临床特征和免疫学指标存在差异，IgM、IgG、IgG2及IgG4可能成为两者临床鉴别的血清学指标。

The aim of this study was to investigate comparatively the clinical characteristics and immunological indicators of immunoglobulin G4 (IgG4)-related dacryoadenitis and lacrimal lymphomas.

105 patients (172 eyes) with IgG4-related dacryoadenitis and 39 patients (46 eyes) with lacrimal lymphoma diagnosed by histopathologist in Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University from June 2011 to June 2019 were enrolled. There were 57 males (78 eyes) and 87 females (140 eyes) with an average age of (55.3±13.6) years-old (ranged from 10 to 89 years-old). The gender, age, eye type, past medical history, clinical manifestations, imaging findings and immunological indicators were recorded and statistics. Age was expressed as ±s, and independent sample t testing was used for comparison. Gender, eye type, past medical history and clinical manifestations were expressed as cases and percentage, and compared using Chi-square test or Fisher′s exact probability method. Immunological indicators were expressed as median and upper and lower quartiles or ±s, and non-parametric rank sum test was used for comparison.

The gender rate (male/female) were 1∶2.75 and 2.9∶1, respectively in IgG4-related dacryoadenitis group and lacrimal lymphoma group. The majority of IgG4-related dacryoadenitis patients were female, while other was male; lacrimal lymphoma was more common in monocular than IgG4-related dacryoadenitis with significant difference (χ²=27.047, 25.486; P<0.05). In the IgG4-related dacryoadenitis group, 24 cases had preoperative glucocorticoid history, accouting for 22.9%; 3 cases with a history of surgery, accouting for 2.9%; 4 cases with asthma, accouting for 3.8%; 4 cases with lymphadenopathy, accouting for 3.8%; 27 cases with sinusitis, accouting for 25.7%; and 3 cases with immune system diseases, accouting for 2.9%. In lacrimal lymphoma group, they were 9 cases, 9 cases, 0, 0, 5 cases and 0, accouting for 23.1%, 23.1%, 0, 0, 12.8%, 0, respectively. The difference between groups in the history of previous surgery was significant using Fisher′s exact probability test (P<0.05). There was no significant difference between groups in preoperative glucocorticoid history and sinusitis (χ²=0.001, 2.735; P>0.05). There were no significant differences in the history of asthma, lymphadenopathy and immune system diseases using Fisher′s exact probability test (P>0.05). The main clinical manifestations of two groups were eyelid swelling. There were 96 cases and 20 cases with eyelid swelling, accouting for 91.4% and 51.3%, respectively in IgG4-related dacryoadenitis group and lacrimal lymphoma group. There was a significant difference in the number of cases of eyelid swelling between two groups (χ²=29.261, P<0.05). The main manifestations through imaging device were lacrimal gland enlargement in both groups. There were 105 cases and 9 cases with eyelid swelling, accouting for 100.0% and 23.1%, respectively in IgG4-related dacryoadenitis group and lacrimal lymphoma group. There was a significant difference in the number of cases of eyelid swelling between two groups (χ²=102.024, P<0.05). The contents of complement 3 (C3), complement 4 (C4), rheumatoid factor (RF), immunoglobulin A (IgA), immunoglobulin M (IgM), C-reactive protein (CRP), anti-streptococcus hemolysin O (ASO), IgG, IgG1, IgG2, IgG3 and IgG4 in IgG4-related dacryoadenitis were 1002.00 (857.00, 1165.45) mg/dl, 204.50 (151.85, 242.73) mg/dl, 7.30 (2.62, 12.93)mg/dl, 48.50 (25.90, 82.35) mg/dl, 1.35 (0.61, 2.56) mg/dl, 2.01 (1.49, 2.78) mg/dl, 0.94 (0.64, 1.31) mg/dl, 1480.00 (1270.00, 1790.00) mg/dl, 674.00 (530.00, 830.50) mg/dl, 534.00 (428.50, 679.00) mg/dl, 53.50 (26.70, 78.35)mg/dl, 155.00 (122.00, 248.00) mg/dl, respectively. There were no significant differences in C3, C4, RF, ASO, CRP, IgA, IgG1 and IgG3 between two groups (Z=-0.040, -1.818, -0.144, -0.620, -0.699, -0.031, -1.731, -0.344; P>0.05). The differences of two groups in IgM, IgG, IgG2 and IgG4 were significant (Z=-3.932, -4.473, -2.821, -5.995; P<0.05).

The clinical features and laboratory indicators of lacrimal lymphoma are different from IgG4-related dacryoadenitis, and IgM, IgG, IgG2 and IgG4 may be the serological indicators for clinical differentiation between them.