IgG4相关肺病一例：病例报告并文献复习

IgG4-Related Lung Disease: A Case Report and Literature Review

摘要: 目的：IgG4相关疾病(IgG4-RD)的诊断是一项复杂的任务，需要考虑广泛的鉴别诊断。方法：回顾性分析1例胸部CT表现状似肿瘤的IgG4相关肺病(IgG4-RLD)患者的病史资料、临床表现、实验室检查结果及治疗转归，并进行文献复习。结果：患者为61岁女性，胸部CT发现多发磨玻璃影，无明显症状，既往体健，无烟酒史。入院前已行肿瘤、结核病影像学及血清学筛查，均为阴性。最终电视胸腔镜下切除的肺组织病理结果显示纤维组织增生伴淋巴细胞和浆细胞浸润，部分区域IgG4+/IgG+细胞比超过40%，符合IgG4相关肺病的诊断标准。给予激素治疗后，患者肺部磨玻璃影吸收明显。结论：IgG4-RLD模拟肺癌甚至二者共病的情况值得重视，临床医生应关注两者的鉴别诊断。

Abstract: Objective: Diagnostic of IgG4-related disease (IgG4-RD) is a complex task, as a broad spectrum of differential diagnoses needs to be considered. Methods: We reviewed a case of IgG4-associated lung disease (IgG4-RLD) with tumor-like chest CT findings, analyzing the medical history, clinical mani-festations, laboratory findings, and treatment outcome, and also carried out a literature review. Results: A 61-year-old female patient was found to have multiple ground-glass opacities on chest CT without fever, cough, hemoptysis, or weight loss. She was previously healthy and had no history of alcohol or smoking. Imaging and serological screening of tumors and tuberculosis were performed before admission and were all negative. The pathological findings of the resected lung specimen af-ter TV thoracoscopy showed fibrous tissue hyperplasia with high lymphocyte and plasma cell infil-tration and IgG4-positive/IgG-positive cell ratio of more than 40% in some areas, meeting the diag-nostic criteria of IgG4-RLD. After glucocorticoid was treated, the chest CT showed that ground-glass opacity in the right lung was significantly absorbed. Conclusion: IgG4-RLD mimicking lung cancer or even comorbidity deserves attention and clinicians should pay attention to the differential diagno-sis between the two.