1型自身免疫性胰腺炎复发的相关危险因素研究

陈升鑫; 翟亚奇; 陈德鑫; 吴浪; 方开萱; 刘文静; 张贯军; 张大涯; 李明阳

doi:10.3969/j.issn.2095-5227.2023.03.003

1型自身免疫性胰腺炎复发的相关危险因素研究

Factors associated with recurrence of type 1 autoimmune pancreatitis

摘要

摘要:
背景自身免疫性胰腺炎(autoimmune pancreatitis，AIP)是一种良性高复发性特殊类型的胰腺炎，其复发相关的危险因素尚无定论。
目的探索1型自身免疫性胰腺炎复发的相关危险因素，旨在为临床诊疗提供依据。
方法回顾性分析2012 - 2020年解放军总医院收治的有完整随访资料的103例AIP患者临床资料，分析与复发相关的影响因素。
结果 103例1型AIP患者中，男性79例，女性24例，平均年龄61.4 ± 10.6(范围：29 ~ 85)岁｡中位随访时间为56(范围：24 ~ 128)个月，其中48.5%(50/103)的病例出现复发；单因素分析显示，腮腺受累(P=0.032)、血清IgG4＞1 140 mg/dL (P=0.014)、血清IgG＞1 945 mg/dL (P=0.033)、血清γ球蛋白＞26.9%(P=0.028)、维持治疗(P=0.005)在两组间的差异有统计学意义。多因素分析显示，血清IgG4＞1 140 mg/dL(OR=2.156)、接受维持治疗(OR=0.642)等因素与1型AIP复发独立关联(P＜0.05)。其中接受维持治疗是保护性因素。
结论初诊时血清IgG4＞1 140 mg/dL是1型AIP复发的独立关联因素，而接受小剂量激素维持治疗能够减少复发。

Abstract:
Background Autoimmune pancreatitis (AIP) is a special type of benign and highly recurrent pancreatitis, and its risk factors for recurrence have not been established.
Objective To explore the risk factors for recurrence of type 1 AIP, so as to raise the clinical awareness of diagnosis and treatment.
Methods Clinical data about 103 patients with AIP admitted to Chinese PLA General Hospital from 2012 to 2020 with complete follow-up data were retrospectively analyzed. Univariate and multivariate analysis were performed to find potential risk factors and protective factors for recurrence.
Results Of the 103 patients with type 1 AIP, 79 cases were male and 24 cases were female, with a mean age of 61.4 ± 10.6 (range: 29-85) years. The median follow-up was 56 (range: 24-128) months, with relapse occurring in 48.5% (50/103) of cases. Univariate analysis showed that parotid involvement (P=0.032), serum IgG4>1140 mg/dL (P=0.014), serum IgG>1 945 mg/dL (P=0.033), serum gamma globulin>26.9% (P=0.028), and maintenance treatment (P=0.005) had statistically significant differences between the two groups. Results of multifactorial analysis showed that serum IgG4>1140 mg/dL (OR=2.156), receiving maintenance therapy (OR=0.642) were independently associated with type 1 AIP recurrence (P<0.05). Among them, receiving maintenance therapy was a protective factor.
Conclusion Serum IgG4>1 140 mg/dL at diagnosis is an independent risk factor for recurrence of type 1 AIP, and low-dose glucocorticoids maintenance therapy can reduce recurrence.

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