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

doi: 10.3969/j.issn.2095-5227.2023.03.003

陈升鑫^{1, 2,},
翟亚奇²,
陈德鑫^{1, 2},
吴浪^{1, 2},
方开萱^{1, 2},
刘文静^{1, 2},
张贯军²,
张大涯²,
李明阳^2, ,

1.
解放军总医院研究生院，北京　100853
2.
解放军总医院第一医学中心消化内科，北京　100853

详细信息

作者简介:
陈升鑫，男，在读硕士，医师。研究方向：自身免疫性胰腺炎。Email: 814238182@qq.com

通讯作者:
李明阳，男，博士，主任医师，教授。Email: mingyangli_pla@163.com

中图分类号: R576
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- 被引次数: 0
出版历程
- 收稿日期: 2022-06-13
- 网络出版日期: 2023-03-23
- 刊出日期: 2023-03-28

Factors associated with recurrence of type 1 autoimmune pancreatitis

CHEN Shengxin^{1, 2
,},
ZHAI Yaqi²,
CHEN Dexin^{1, 2},
WU Lang^{1, 2},
FANG Kaixuan^{1, 2},
LIU Wenjing^{1, 2},
ZHANG Guanjun²,
ZHANG Daya²,
LI Mingyang^{2
, ,}

1.
Graduate School, Chinese PLA General Hospital, Beijing 100853, China
2.
Department of Gastroenterology, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China

More Information

Corresponding author: LI Mingyang. Email: mingyangli_pla@163.com

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。
- 自身免疫性胰腺炎 /
- IgG4相关胰腺炎 /
- 复发 /
- 危险因素 /
- 保护因素
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.
- autoimmune pancreatitis /
- IgG4-related pancreatitis /
- recurrence /
- risk factor /
- protective factor

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表 1 1型AIP复发组与非复发组的临床基线资料对比结果

Table 1. Comparison of clinical baseline data between type 1 AIP relapse group and non-relapse group

指标	复发组 (n=50)	非复发组 (n=53)	χ²/t/Z值	P值
年龄/(岁，$\bar x \pm s $)	61.7 ± 1.8	61.2 ± 1.1	1.689	0.095
BMI/[kg·m^-2，Md(IQR)]	22.6 (21.2，24.6)	22.0 (20.9，23.9)	0.406	0.685
性别/例			0.027	0.871
男	38	41
女	12	12
既往史/(例，%)
吸烟	25(50.0)	26(49.1)	0.009	0.924
饮酒	27(54.0)	25(47.2)	0.480	0.488
糖尿病	12(24.0)	8(15.1)	1.304	0.253
风湿免疫疾病	3(6.0)	4(7.5)	0.000	0.755
临床症状/(例，%)
梗阻性黄疸	34(68.0)	38(71.7)	0.167	0.683
腹痛/腹部不适	22(44.0)	16(30.2)	5.068	0.147
消瘦	27(54.0)	29(54.7)	0.005	0.942
急性胰腺炎	1(2.0)	4(7.5)	0.723	0.395
无症状	2(4.0)	6(11.3)	1.039	0.308
胰腺外器官受累/(例，%)
胆管	25(50.0)	22(41.5)	0.728	0.387
淋巴结	38(76.0)	42(79.2)	0.156	0.693
腮腺	14(28.0)	6(11.3)	4.574	0.032
肾	8(16.0)	2(3.8)	3.322	0.068
炎性肠病	2(4.0)	3(5.7)	0.000	1.000
腹膜后纤维化	2(4.0)	2(3.8)	0.000	1.000

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表 2 1型AIP复发组与非复发组的影像学、血清学、治疗方案比较(例，%)

Table 2. Comparison of imaging, serology, and treatment regimen between type 1 AIP relapse group and non-relapse group (n, %)

指标	复发组(n=50)	非复发组(n=53)	χ²值	P值
影像学
胰腺弥漫性肿大	30(60.0)	29(54.7)	0.293	0.588
胰腺局灶/节段肿大	20(40.0)	24(45.3)
胆管扩张	38(72.0)	40(75.5)	0.004	0.950
胰管扩张	17(34.0)	25(47.2)	1.848	0.174
胰腺萎缩	3(6.0)	4(7.6)	0.000	1.000
胰腺囊肿	4(8.0)	1(1.9)	0.969	0.325
胰腺钙化或结石	2(4.0)	0(0)	-	0.233
血清学
IgG4＞1140 mg·dL^-1	28(56.0)	17(32.1)	5.986	0.014
IgG＞1 945 mg·dL^-1	20(40.0)	11(20.8)	4.525	0.033
IgE＞100 IU·dL^-1	37(74.0)	33(62.3)	1.562	0.211
IgA＞293 mg·dL^-1	14(28.0)	7(13.2)	3.468	0.063
CA199＞204 U·mL^-1	14(28.0)	9(17.0)	1.801	0.180
红细胞沉降率　　＞57 mm·h^-1	12(24.0)	6(11.3)	2.760	0.097
γ-GGT＞723 U·L^-1	16(32.0)	11(20.8)	1.682	0.195
γ球蛋白＞26.9%	18(36.0)	9(17.0)	4.811	0.028
嗜酸性粒细胞　　百分比＞0.07%	24(48.0)	18(34.0)	2.425	0.119
初始治疗方法
激素	22(44.0)	18(34.0)	1.091	0.296
胆道引流术	2(4.0)	2(3.8)	0.000	1.000
手术切除	4(8.0)	6(11.3)	0.056	0.813
胆道引流术 + 激素	5(10.0)	7(13.2)	0.257	0.612
免疫抑制剂 + 激素	12(24.0)	16(30.2)	0.498	0.480
保守治疗	5(10.0)	4(7.5)	0.008	0.927
维持治疗	13(26.0)	28(52.8)	7.730	0.005

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表 3 1型AIP复发关联因素多因素逐步回归分析结果

Table 3. Results of multivariable stepwise regression analysis of factors associated with type 1 AIP recurrence

指标/因素	变量赋值	β值	标准误	Wald χ²值	P值	OR值	OR 95% CI
常数	-	0.126	0.383	0.108	0.743	1.134	-
IgG4	＞1140 mg·dL^-1=1，≤1140 mg·dL^-1=0	0.987	0.480	4.232	0.040	2.683	1.048 ~ 6.868
维持治疗	维持治疗=1，否=0	-1.329	0.481	7.644	0.006	0.265	0.103 ~ 0.679

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