自身免疫性胰腺炎43例诊治分析

Diagnosis and management of autoimmune pancreatitis: An analysis of 43 cases

  • 摘要: 目的 总结我院自身免疫性胰腺炎的临床特点并进一步探讨其诊治经验。 方法 回顾性分析我院2011年1月- 2014年6月收治的43例自身免疫性胰腺炎患者的临床资料。 结果 43例中,男女比例4.4∶1,年龄平均(57.4±12.0)岁。首发症状为黄疸25例(58.1%),腹部不适16例(37.2%),纳差2例(4.7%),就诊时体质量明显减轻22例(51.2%)。白蛋白/球蛋白比值< 1.5的有38例(88.4%),血清淀粉酶增高5例(11.6%),CA19-9> 100 U/ml 7例(16.3%),γ-球蛋白阳性率93.3%(14/15),IgG4阳性90.7%(39/43)。CT/MRI提示胰腺弥漫性肿大28例(65.1%),局限性肿大15例(34.9%)。PET/CT正确诊断率为58.3%(7/12)。行手术治疗5例(11.6%),激素治疗缓解率100%(43/43),6例过早停药复发。 结论 结合临床症状、血液学及影像学检查可提高自身免疫性胰腺炎的正确诊断率,必要时可行针刺细胞学检查或激素诊断性治疗,标准的激素治疗仍然是自身免疫性胰腺炎的首选。

     

    Abstract: Objective To clarify the clinical characteristics of autoimmune pancreatitis (AIP) and explore the experience of diagnosis and treatment. Methods Clinical data about 43 patients with a diagnosis of AIP in Chinese PLA General Hospital from January 1, 2011 to June 1, 2014 were retrospectively analyzed. Results The ratio of male to female was 4.4:1 with an average age of 57.4±12.0 years old in 43 patients with AIP. Obstructive jaundice was the most frequent initial symptom (58.1%), followed by abdominal discomfort (37.2%) and anorexia (4.7%). More than half of patients were complicated with weight loss (51.2%). The albumin/ globulin ratio of 38 (88.4%) patients’ serum was lower than 1.5, serum amylase increased in 5 cases (11.6%) and serum CA19-9 level above 100 U/ml occurred in 7 patients (16.3%). Serum immunoglobulin G4 levels were elevated in 39 cases (90.7%) and serum gamma globulin levels were elevated in 14 (93.3%) cases. Diffuse swelling of the pancreas was found in 28 patients (65.1%) and segmental swelling of the pancreas in 15 cases (34.9%). The correct rate of diagnosis upon PET/CT was 58.3% (7/12). The incidence of benign disease post-operation for a presumed malignancy was 11.6% (5/43). The remission rate of steroid-treated AIP was 100% and the relapsing rate within 12 months was 14.0% (6/43) without maintenance therapy. Conclusion Combining clinical symptoms, blood test, computed tomography (CT) and magnetic resonance (MR) findings together can effectively increase the correct diagnosis rate of AIP. When a diagnosis of AIP is highly suspected, a biopsy is recommended, and a short course of steroid treatment should be considered if the biopsy does not reveal features suspicious for malignancy. The standard treatment for AIP is steroid therapy.

     

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