临床与病理杂志2025，Vol.45Issue(6)：673-679,7.DOI:10.11817/j.issn.2095-6959.2025.241066
高IgG4水平Graves病患者的临床特征
Clinical characteristics of Graves'disease patients with elevated serum immunoglobulin G4 levels
摘要
Abstract
Objective:Graves'disease(GD)is an autoimmune thyroid disorder characterized by hyperthyroidism,goiter,and positivity for thyroid-stimulating hormone receptor antibodies(TRAb).A subset of patients present with elevated immunoglobulin G4(IgG4)levels,which may represent a distinct clinical subtype.This study aims to investigate the clinical features,laboratory parameters,treatment response,and long-term prognosis of GD patients with elevated IgG4 levels to improve recognition and provide a basis for individualized management. Methods:A retrospective cohort study was conducted on 159 newly diagnosed GD patients admitted to Xiangya Third Hospital of Central South University between June and December 2021.Patients were divided into an IgG4-positive(≥2.01 g/L)and an IgG4-negative group(<2.01 g/L)groups.Baseline clinical data and thyroid function parameters[free triiodothyronine(FT3),free thyroxine(FT4),thyroid-stimulating hormone(TSH),TRAb,thyroglobulin antibodies(TgAb),thyroid peroxidase autoantibodies(TPOAb)]were collected.Systemic autoantibodies[antinuclear antibody(ANA)and extractable nuclear antigen(ENA)antibody profiles]were also assessed.Patients were followed at 1,3,6,9,12,and 24 months after treatment to evaluate thyroid function and antibody changes.After 3 years,discontinuation and relapse rates were obtained via telephone follow-up. Results:Among 159 included patients,26 were IgG4-positive and 133 were IgG4-negative.IgG4-positive patients had significantly higher serum IgG4 levels and a higher proportion of males(both P<0.05).Compared with the IgG4-negative group,IgG4-positive patients showed elevated FT3,TPOAb,TGAb,and globulin levels,with a lower albumin-to-globulin ratio(all P<0.05);ANA positivity at titers of 1:80,1:160,1:320,1:1 000,and positivity for anti-SM,anti-SSA,and anti-UM-RNP antibodies were also higher(all P<0.05).No differences were found in age of onset,FT4,TSH,or TRAb(all P>0.05).Follow-up of 24 IgG4-positive and 93 IgG4-negative patients showed that at 12 months,TPOAb and TGAb remained higher in IgG4-positive patients,while at 24 months FT3 and FT4 were higher(all P<0.05).After 3 years,the discontinuation rate was lower in the IgG4-positive group(47.62％vs 71.26％,P=0.039)and relapse rate was higher(28.57％vs 14.94％),though the latter was not statistically significant(P=0.249). Conclusion:GD patients with elevated IgG4 levels are more frequently male,with higher FT3 and thyroid autoantibody levels and a more active systemic autoimmune profile.This subgroup has a lower treatment discontinuation rate and a higher relapse tendency,suggesting a more protracted disease course and poorer prognosis.Strengthened clinical recognition,long-term follow-up,and individualized treatment strategies are recommended,with attention to potential multisystem immune abnormalities.关键词
免疫球蛋白G4/Graves病/甲状腺过氧化物酶自身抗体/甲状腺球蛋白抗体/抗核抗体Key words
immunoglobulin G4/Graves'disease/thyroid peroxidase autoantibody/thyroglobulin antibody/antinuclear antibody引用本文复制引用
付怡雯,覃恬恬,赵少俐,何红晖,金萍..高IgG4水平Graves病患者的临床特征[J].临床与病理杂志,2025,45(6):673-679,7.基金项目
湖南省自然科学基金(2024JJ9052).This work was supported by the Natural Science Foundation of Hunan Province,China(2024JJ9052). （2024JJ9052）
