IgG4 ᛶ ᝈ䛸 ᶫᮏ ᕫච ᛶ ⅖ ḷᒣ Ꮫ య Ꮫ ぬ㐨

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1 IgG4

2 Autoimmune pancreatitis Histopathological features: Diffuse lymphoplasmacytic infiltration Stromal fibrosis Acinar atrophy Obliterative phlebitis 1. Hamano et al reported that serum IgG4 levels were especifically elevated in patients with autoimmune pancreatitis (AIP). (N Engl J Med, 2001,344: ) 2. Hamano et al found abundant infiltration of IgG4-positive plasma cells in pancreatic lesion of patients with AIP. (Lancet, 2002, 359: ) 3. Park DH et al: Recent advances in autoimmune pancreatitis. GUT, 2009, 12:

3 IgG4 positive plasma cells and thyroiditis The IgG4-positive plasma cell rich group was termed as: ; IgG4-positive plasma cell poor group was termed as: non-igg4 thyroiditis (Cut-off value: >20/HPF IgG4-positive plasma cells and >30% IgG4/IgG ratio). Yaqiong Li et al. Immunohistochemistry of IgG4 can help subclassify Hashimoto s autoimmune thyroiditis. Pathology International 2009; 59:

4

5

6 >20/HPF IgG4-positive plasma cells and >30% IgG4/IgG ratio IgG4 IgG4 IgG (n=28) IgG non- (n=77)

7 IgG4-positive plasma cell infiltrate: A marker of more fibrotic disease in HT Hashimoto s autoimmune thyroiditis (HT) (n=28) non-igg4 thyroiditis (n=77) P value Number of IgG4+ plasma cells per HPF Number of IgG+ plasma cells per HPF IgG4/IgG plasma cells (%) Stromal fibrosis (3+, 2+, 1+, 0) Lymphoplasmacytic infiltration (3+, 2+, 1+, 0) Follicular cell degeneration (3+, 2+, 1+, 0) Lymphoid follicle formation (3+, 2+, 1+, 0) 17/7/4/0 10/19/34/14 < /4/0/0 24/21/32/0 < /5/2/0 13/21/34/9 < /12/13/0 15/17/45/

8 Comparison of clinical, serological and sonographic features Disease duration Disease duration (years) Hashimoto s thyroiditis non Disease duration (years) P= Non- non-

9 Comparison of clinical, serological and sonographic features Gender Hashimoto s thyroiditis Gender non- Male Non- P= Female Male Female

10 Comparison of clinical, serological and sonographic features Thyroid functional status* Hashimoto s thyroiditis non- Weight of thyroid gland (g)* (110.8; 232.0) (115.4; 225.5) L-T4 (ug/day)* 75 (50; 100) 50 (0; 100) Thyroid functional status* 6/11/1 5/36/8 Subclinical hypothyroidism euthyroidism Subclinical hype rthyroidis m IgG4 non-igg Thyroid function (number of patients)

11 Comparison of clinical, serological and sonographic features Thyroid autoantibodies Thyroid autoantibodies Hashimoto s thyroiditis non- Tg-Ab (fold) TPO-Ab (fold) Serum Tg-Ab (fold) P= Non- Serum TPO-Ab (fold) P= Non-

12 and non-: Distinct clinical, serological and sonographic charactertistics Hashimoto s autoimmune thyroiditis (HT) (n=28) non- (n=77) P value Age (yr) Gender (Male/Female) 7/21 3/ Disease duration (yr) Thyroid functional status* (Subclinical hypo-/eu- /Subclinical hyper) 6/11/1* 5/36/8* ESR (mm/hr) Tg-Ab (fold) TPO-Ab (fold) Echogenicity (ultrasound) (diffuse low/coarse) 19/9 19/

13 Serum concentrations of IgG subclasses in (12 cases) and non- (10 cases) Serum IgG subclasses (n=12) non- (n=10) P value IgG1 (mg/dl) IgG2 (mg/dl) IgG3(mg/dl) IgG4 (mg/dl) P<0.001 *Reference value of serum IgG4 concentration: mg/dl Non Serum IgG4 concentration (mg/dl)

14 Comparison of serum IgG4 concentration before operation and after operation Serum IgG4 concentration Before operation P<0.005 After operation Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 Patient 8 Patient 9 Patient 10 Patient 11 Patient 12

15 IgG4 (mg/dl) IgG4 P=

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17 Comparison of clinical, serological and sonographic features Difference in Echogenicity Echo - genicity Hashimoto s thyroiditis non diffuse low diffuse coarse P= Diffuse low Diffuse coarse non-

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