广西医学

目的探讨术前血清IgG4水平与克罗恩病患者回结肠切除术后复发的相关性。方法纳入因克罗恩病接受回结肠切除术的119例患者，术后进行为期5年的随访，记录复发情况。采用COX回归模型分析克罗恩病患者回结肠切除术后复发的独立影响因素。绘制受试者工作特征（ROC）曲线和决策曲线，分析术前血清IgG4水平及其他影响因素对克罗恩病患者回结肠切除术后复发的预测价值及净收益率。分析术前血清IgG4水平与术前克罗恩病活动指数、部分炎症指标的相关性。结果多因素COX回归分析结果显示，术前血清IgG4、C反应蛋白（CRP）、肿瘤坏死因子α（TNF⁃α）水平及克罗恩病活动指数为克罗恩病患者回结肠切除术后复发的独立影响因素（P<0.05），其中术前血清IgG4水平每增加1 g/L，克罗恩病患者回结肠切除术后复发的风险增加1.255倍。ROC曲线分析结果显示，术前血清IgG4、CRP、TNF⁃α水平及克罗恩病活动指数预测克罗恩病患者回结肠切除术后复发的曲线下面积（AUC）为0.724~0.864，且具有良好的净获益；4个指标联合预测的AUC（0.952）及总体净效益均优于单一指标。术前血清IgG4水平与术前血清CRP、TNF⁃α水平及克罗恩病活动指数呈正相关（P<0.05）。结论术前血清IgG4水平与克罗恩病患者回结肠切除术后复发密切相关，有助于评估患者术后复发风险。

Objective To investigate the correlation of preoperative serum IgG4 level with the recurrence of patients with Crohn's disease after ileocolectomy. Methods A total of 119 patients with Crohn's disease receiving ileocolectomy were enrolled. All patients were followed up for 5 years after surgery, and the recurrence conditions were recorded. The COX regression model was used to analyze the independent influencing factors for the recurrence of patients with Crohn's disease after ileocolectomy. The receiver operating characteristic (ROC) curve and decision analysis curve were drawn to analyze the predictive value and net benefit rate of preoperative serum IgG4 level and other influencing factors for the recurrence of patients with Crohn's disease after ileocolectomy. The correlation of preoperative serum IgG4 level with preoperative Crohn's disease activity index and partial inflammatory indices was analyzed. Results The results of multivariate COX regression analysis revealed that preoperative serum IgG4, C⁃reactive protein (CRP), tumor necrosis factor α (TNF⁃α) levels, and Crohn's disease activity index were the independent influencing factors for the recurrence of patients with Crohn's disease after ileocolectomy (P<0.05), therein for every 1 g/L increase in preoperative serum IgG4 level, the recurrence risk of patients with Crohn's disease after ileocolectomy increased by 1.255 times. The results of ROC curve analysis indicated that areas under the curve (AUC) of preoperative serum IgG4, CRP, TNF⁃α levels and Crohn's disease activity index for predicting the recurrence of patients with Crohn's disease after ileocolectomy were 0.724-0.864, exerting favorable net benefits; in addition, AUC predicted by the combination of the 4 indices (0.952) and overall net benefit were superior to any single index. Preoperative serum IgG4 level positively correlated with preoperative serum CRP and TNF⁃α levels, as well as Crohn's disease activity index (P<0.05). Conclusion Preoperative serum IgG4 level is closely related to the recurrence of patients with Crohn's disease after ileocolectomy, which is helpful to postoperative recurrence risk evaluation in patients.