RESUMO
Objective:To investigate the value of immunoglobulin G4 (IgG4) and IgG4/ immunoglobulin G (IgG) ratio in the differential diagnosis of IgG4-related diseases (IgG4-RD) and other autoimmune diseases.Methods:A total of 35 patients with IgG4-RD and 937 patients with autoimmune diseases who received treatment in Beijing Hospital from January 2021 to July 2022, and 200 subjects who concurrently underwent health checkups in the same hospital were included in this study. The IMMAGE 800 and BN II automatic special protein analyzers were used to detect IgG and IgG4. The receiver operating characteristic (ROC) curve of IgG4 and IgG4/IgG ratio was plotted.Results:Serum IgG4 level and IgG4/IgG ratio in the IgG4-RD group were 2.83 (2.01, 5.07) g/L and 25% (18%, 43%) respectively, which were higher than 0.35 (0.16, 0.72) g/L, 3% (1%, 6%) in the autoimmune disease group and 0.27 (0.14, 0.49) g/L, 2% (1%, 4%) in the healthy control group ( U = 795.50, 82.50, 1 744.50, 205.50, all P < 0.001). Taking IgG4 ≥ 1.35 g/L as the standard, patients with IgG4 ≥ 1.35 g/L in the three groups were screened out. There was a statistically significant difference in IgG4/IgG ratio between the IgG4-RD group and the non-IgG4-RD group ( U = 453.50, P < 0.001). The ROC curve of IgG4 and IgG4/IgG ratio showed that when IgG4 was 1.47 g/L, the sensitivity was 91.7%, the specificity was 83.5%, and the area under the ROC curve was 0.96. When IgG4/IgG was 12.5%, the sensitivity was 91.4%, the specificity was 85%, and the area under the ROC curve was 0.96. Taking IgG4 ≥ 1.47 g/L and IgG4/IgG ≥ 12.5% as the diagnostic criteria of IgG4-RD, the sensitivity was 94.3%, the specificity was 85.9%, and the area under the ROC curve was 0.96, which were higher than the sensitivity (87.2%) and diagnostic specificity (82.6%) provided by IgG4 alone. Conclusion:Because non-IgG4-RD diseases can also have the phenomenon of increased IgG4, when IgG4 ≥ 1.47 g/L is taken as the diagnostic criteria, its diagnostic sensitivity and specificity are the highest. Combined detection of IgG4 and IgG4/IgG ratio can increase the diagnostic efficacy of IgG4-RD.
RESUMO
OBJECTIVE:To investigate the effects of tirofiban combined with atorvastation before PCI on the miRNA expres-sion of peripheral blood and vascular endothelial function in acute myocardial infarction(AMI)patients. METHODS:A total of 80 patients with AMI selected from our hospital as reaserch objects during Jan. 2015-Jun. 2016 were divided into control group and ob-servation group according to random number table,with 40 cases in each group. Both groups received anticoagulant therapy. Con-trol group was given Aspirin enteric-coated tablets 300 mg+Clopidogrel sulfate tablets 75 mg+ Atorvastatin calcium tablets 20 mg orally 30 min before PCI. Observation group was additionally given Tirofiban hydrochloride for injection with initial dose of 0.5 mg+0.9％ Sodium chloride injection 100 mL,iv,then adjusted to pump injection of 0.4 μg/(kg·min),30 min later adjusted to pump injection of 0.1 μg/(kg·min),for consecutive 24 h. The levels of peripheral miRNA (miRNA-1,miRNA-133a,miR-NA-208b,miRNA-499),the levels of brachial artery diameter and vascular endothelial function indexes(vWF,ET-1,NO)were observed in 2 groups before medication and after PCI,and the occurrence of ADR was recorded. RESULTS:Before treatment, there was no statistical significance in above indexes between 2 groups(P>0.05). After treatment,miRNA expression,the levels of vWF and ET-1 were decreased significantly in 2 groups,and observation group was significantly lower than control group,with statistical significance (P<0.05). The brachial artery diameter and NO levels of 2 groups were increased significantly,and observation group was significantly greater or higher than con-trol group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLU-SIONS:For AMI,tirofiban combined with atorvastation before PCI can reduce miRNA expression,increase brachial artery diame-ter and protect vascular endothelial function with good safety.