IgG4相关鼻窦炎3例临床诊治

魏蕾; 胡娅琴; 李晓晓; 罗锐; 邹帆; 钟雪; 袁伟; 陈红江

doi:10.16016/j.2097-0927.202306062

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IgG4相关鼻窦炎3例临床诊治

临床医学 | 更新时间：2026-01-09

- IgG4相关鼻窦炎3例临床诊治
- Clinical diagnosis and treatment for 3 cases of IgG4-related sinusitis
- 陆军军医大学学报 2023年45卷第17期页码：1877-1882
- 作者机构：
  
  1.401147 重庆，重庆市人民医院：耳鼻咽喉科
  2.401147 重庆，重庆市人民医院：老年科
- 作者简介：
  
  [陈红江; E-mail: chenhj_1999@163.comCHEN Hongjiang, E-mail: chenhj_1999@163.com
- 基金信息：
  
  重庆市科卫联合医学科研中青年医学高端人才项目(2019GDRC003);重庆市人民医院医学科技创新基金重点项目(Y2019ZDXM05);重庆市科卫联合面上项目(2021MSXM048)
- DOI：10.16016/j.2097-0927.202306062
  中图分类号： R392.8;R765.21
- 收稿：2023-06-19，
  
  修回：2023-07-26，
  
  纸质出版：2023-09-15
- 稿件说明：
移动端阅览
魏蕾, 胡娅琴, 李晓晓, 等. IgG4相关鼻窦炎3例临床诊治[J]. 陆军军医大学学报, 2023,45(17):1877-1882.

Lei WEI, Yaqin HU, Xiaoxiao LI, et al. Clinical diagnosis and treatment for 3 cases of IgG4-related sinusitis[J]. Journal of Army Medical University, 2023, 45(17): 1877-1882.
魏蕾, 胡娅琴, 李晓晓, 等. IgG4相关鼻窦炎3例临床诊治[J]. 陆军军医大学学报, 2023,45(17):1877-1882. DOI： 10.16016/j.2097-0927.202306062.

Lei WEI, Yaqin HU, Xiaoxiao LI, et al. Clinical diagnosis and treatment for 3 cases of IgG4-related sinusitis[J]. Journal of Army Medical University, 2023, 45(17): 1877-1882. DOI： 10.16016/j.2097-0927.202306062.

摘要

目的

总结IgG4相关鼻窦炎的临床特征、治疗方案及效果，以提高临床医生对该疾病的认识。

方法

对2019年1月至2023年1月在我院确诊的3例IgG4相关鼻窦炎患者的临床资料进行回顾性描述性研究，分析其临床表现、检验指标、影像学资料、手术方式、术后病理、治疗措施及随访结果，并结合相关文献复习。

结果

3例患者中，男性1例，女性2例。年龄53~71岁，平均63岁。病程1~5年。主要症状为鼻塞、耳闷、眼睑肿块、颈部淋巴结及颌下腺肿大。3位患者血清IgG4均增高，为3.2~4.7 g/L。鼻窦CT检查提示全组鼻窦炎伴鼻息肉。影像学检查未发现头颈部以外的器官受累及。3例患者均行功能性鼻内镜鼻窦开放及鼻息肉切除手术，经组织病理及免疫组化染色确诊IgG4相关鼻窦炎。术后常规行鼻喷激素及鼻腔冲洗等治疗，术后3~10个月均出现病情复发，复发后予口服醋酸泼尼松片30~40 mg/d诱导缓解治疗1个月，病情均得到控制。醋酸泼尼松逐渐减量至5 mg/d长期维持。其中1例患者联合口服免疫抑制剂吗替麦考酚酯治疗。3例患者随访14~32个月，病情无复发。

结论

IgG4相关鼻窦炎临床特征与慢性鼻窦炎类似，其诊断需依赖病理检查。首选治疗为激素治疗，小剂量激素维持治疗是防止复发的关键，激素联合免疫抑制剂治疗能更有效控制病情。

Abstract

Objective

To summarize the clinical characteristics

treatment regimens

and outcomes of IgG4-related sinusitis in order to improve clinicians' knowledge of the disease.

Methods

A retrospective descriptive study was conducted on 3 cases of IgG4-related sinusitis admitted to our hospital from January 2019 to January 2023. Their clinical manifestation

results of laboratory tests

radiological findings

surgical methods

postoperative pathologic results

treatment and managements

and outcomes during follow-up were analyzed

and relevant literature was also reviewed.

Results

Among the 3 patients

there were 1 male and 2 females

at an average age of 63 (53 to 71) years

with a course of disease for 1~5 years. The main symptoms included nasal congestion

ear fullness

eyelid lumps

cervical lymphadenopathy and enlarged submandibular gland. Serum IgG4 level was elevated to 3.2~4.7 g/L. Sinus CT scans confirmed sinusitis with nasal polyps. No involvement of organs other than the head and neck was observed in radiological examination. All 3 cases underwent functional endoscopic sinus surgery and polypectomy. Post-surgical pathology confirmed IgG4-related sinusitis. Other treatments included nasal steroids and nasal lavage conventionally. Recurrence of the disease was noted 3~10 months postoperatively

then 30~40 mg/d prednisone acetate was given orally as induction therapy for 1 month

which effectively controlled the conditions in all cases. The dose of prednisone acetate was gradually reduced to 5 mg/day for long-term maintenance. One patient took oral immunosuppressant mycophenolate mofetil in combination. All 3 patients were followed up for 14~32 months

and no further recurrence was observed.

Conclusion

IgG4-related sinusitis shows similar clinical characteristics as chronic sinusitis

and pathologic observation is essential for its diagnosis. Its preferred treatment is steroid therapy

particularly low-dose long-term as maintenance

is key to preventing recurrence. Combined steroid and immunosuppressant therapy can more effectively control the condition of disease.

关键词

Keywords

references

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