中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (09): 812-815.

• 论著 • 上一篇    下一篇

自身免疫性胰腺炎1例报告并国内文献复习

王科伟，李昱骥，孔凡民，周建平，董    明，田雨霖   

  1. 中国医科大学附属第一医院普通外科教研室  胃肠外科，辽宁沈阳 110001
  • 出版日期:2011-09-01 发布日期:2011-08-19

  • Online:2011-09-01 Published:2011-08-19

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摘要：

目的    探讨自身免疫性胰腺炎（AIP）的临床特征及其诊断与治疗。方法    报告中国医科大学附属第一医院2011年3月收治1例AIP的临床资料，并检索2001年1月至2010年12月国内10年文献报道18篇107例。对所有108例AIP临床表现、实验室检查、影像学检查、治疗方法及随访资料进行分析。结果    男98例，女10例。临床表现为梗阻性黄疸80例次，上腹部不适或疼痛50例次。健康检查发现1例（无症状）。行CA19-9检查86例中38例(44.2%)阳性，多为轻度升高。行免疫球蛋白（IgG）检查81例中56例（69.1%）升高，行球蛋白或γ球蛋白检查42例中29例（69.0%）升高。行B超及CT检查，108例中弥漫性胰腺肿大54例（50.0%），局限性肿大54例（50.0%），主要为胰头部肿大（51例），胰体部或胰体尾部肿大仅3例。53例行手术治疗，63例行激素治疗。应用激素治疗者2例无效，其余临床症状均有所缓解。7例复发，再次应用激素治疗后症状缓解。结论    AIP好发于中老年男性（55岁左右），多以梗阻性黄疸、腹部不适首诊，伴有IgG和球蛋白的升高，影像学以胰腺弥漫性或局限性肿大为特征，激素治疗效果良好。

关键词: 自身免疫, 慢性胰腺炎, 黄疸

Abstract:

Diagnosisi and treatment of autoimmune pancreatitis:one case report and literature review in China        WANG Ke-wei, LI Yu-ji, KONG Fan-min, et al. Department of Gastrointestinal Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001,China
Corresponding author: Dong Ming,E-mail: mingdong@mail.cmu.edu.cn
Abstract    Objective    this paper summarizes the clinical data of one hundred and eight patients to explore the methods of dianosis and treatment of the AIP. Methods    There has been one AIP patient received and cured in our hospital in 2011,March. The auther searched other 107 paitents from literature documents from January of 2001 to December of 2010.And then this paper made analysis according to these 108 clinical expressions,laboratory examinations,image detection,the methods of treatment and the follow-up data. Results    The clinical manifestations were obstructive jaundice in 80 patients,upper abdominal discomfort or pain in 50 patients, and asymptomatic in one patient. 86 patients checked CA19-9 and the results were positive in 38 cases, mostly for mildly elevated. 81 cases` Immunoglobulin (IgG) had been detected,and among them, 56 cases increased. The patients had CT findings of diffuse pancreatic enlargement in 54 cases,and local pancreatic enlargement in 54 cases .55 cases had accepted surgical treatment, 63 cases had accepted hormone therapy. In the 63 hormone-treated patients only 2 cases were ineffective, the other`s clinical symptoms were eased. 7 cases were relapse, but they were remission after using hormone again. Conclusion    AIP often occurs in middle-aged female.Its main clinical manifestations are obstructive jaundice and abdominal discomfort. IgG and globulin often increase.The imaging is charactered by the diffuse or local enlargement of pancrease. Hormone treatment is very effective.

Key words: autoimmune, chronic pancreatitis, jaundice