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Clinical features and relapse risks factors of IgG4 related disease: a single-center retrospective study

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Abstract

Objective

The aim of this study was to observe the demographic and clinical characteristics of immunoglobulin (Ig) G4–related disease (IgG4-RD). We aimed to compare different treatment methods and to identify the risk factors for non-response and relapse after treatment.

Methods

We performed a retrospective study of 201 IgG4-RD patients initially diagnosed and treated at the First Affiliated Hospital of China Medical University from January 2016 to December 2020. Patients’ sex, age, clinical manifestations, baseline biochemical values, the number of organs involved, and the type of organ involvement were recorded. All patients received glucocorticoid (GC) monotherapy or GC + immunosuppressant combination therapy. The serum IgG4 concentration as well as the details of clinical response, relapse, and side effects were recorded at 1, 3, 6, and 12 months after treatment.

Results

The incidence of IgG4-RD was primarily centered in the age group of 50–70 years old, and the proportion of affected male patients increased with age. The most common clinical symptom was swollen glands or eyes (42.79%). The rates of single- and double-organ involvement were 34.83% and 46.27%, respectively. The pancreas (45.77%) was the most frequently involved organ in cases of single-organ involvement, and the pancreas and biliary tract (45.12%) was the most common organ combination in cases of double-organ involvement. Correlation analysis showed that the number of organs involved was positively related to the serum IgG4 concentration (r = 0.161). The effective rate of GC monotherapy was 91.82%, the recurrence rate was 31.46%, and the incidence of adverse reactions was 36.77%. Meanwhile, the effective rate of GC + immunosuppressant combination therapy was 88.52%, the recurrence rate was 19.61%, and the adverse reaction rate was 41.00%. There were no statistically significant differences in response, recurrence, and adverse reactions. The overall response rate within 12 months was 90.64%. Age (< 50 years old) and aorta involvement were significantly associated with non-response. The overall recurrence rate within 12 months was 26.90%. Age (< 50 years old), low serum C4 concentration, a high number of involved organs, and lymph node involvement were significantly associated with recurrence.

Conclusion

The clinical features vary among different age groups and according to gender. The number of organs involved in IgG4-RD is related to the serum IgG4 concentration. Age (< 50 years old), low serum C4 concentration, a high number of involved organs, and lymph node involvement are risk factors for recurrence.

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Data availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

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Author notes

  1. Lin Guan and Yiling Li have contributed equally to this work.

Authors and Affiliations

  1. Gastroenterology Department, The First Affiliated Hospital of China Medical University, No.155 North Nanjing Street, Heping District, Shenyang, 110001, Liaoning, China

    Xinhe Zhang, Zilu Zeng, Ningning Wang, Ying Wang, Jing Tong, Bing Chang, Xiuli Jin, Die Huang, Yanmeng Wang, Huipeng Cui, Lin Guan & Yiling Li

  2. The 3rd Clinical Department, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China

    Haoyu Tian

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Contributions

YL designed the study; NW, YW, JT and BC collected the data; XZ, XJ, HT, DH, YW and HC organized data; XZ and ZZ wrote the original draft; XZ, YL and LG reviewed and edited; All authors read, revised and approved the final manuscript.

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Correspondence to Lin Guan or Yiling Li.

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The authors declare no competing interests.

Ethics approval

The study was conducted in accordance with Declaration Helsinki. The ethics committee waived the requirement for informed consent because of the retrospective nature of the study. But the protocol was approved by the Ethics Committee of the First Hospital of China Medical University ([2022]20).

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Zhang, X., Zeng, Z., Tian, H. et al. Clinical features and relapse risks factors of IgG4 related disease: a single-center retrospective study. Clin Exp Med 23, 3527–3538 (2023). https://doi.org/10.1007/s10238-023-01123-z

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