中国实用外科杂志

中国实用外科杂志

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自身免疫性胰腺炎25例分析

唐    能，罗    东，刘国栋，纪连栋，柯牧京，欧政林，李宜雄   

  1. 中南大学湘雅医院普外科，湖南长沙 410000
  • 出版日期:2018-04-01 发布日期:2018-03-30

  • Online:2018-04-01 Published:2018-03-30

摘要：

目的    总结分析自身免疫性胰腺炎（AIP）的临床特点及诊治经验。方法    回顾性分析2012年9月至2016 年11月中南大学湘雅医院收治的25例AIP 病人的临床资料。结果    25例AIP病人中，男女比例2.6:1，中位发病年龄54 岁（33～77岁）；常见症状为黄疸15例（60.0%），腹痛11例（44.0%）；15例（60.0%）合并其他器官受累；23例检测CA19-9，明显升高（＞100 kU/L）仅3例（13.0%）；19例检测IgG，升高17例（89.5%）；12例检测IgG4，阳性11例（91.7%）。23例行CT检查，14例（60.9%）考虑为AIP，12例行磁共振胰胆管成像（MRCP）检查，6例（50.0%）考虑为AIP。未行激素治疗11例，14例行激素治疗，随访2～50月，中位随访时间为24个月，11例（78.6%）病人激素治疗有效。结论    受累器官组织学活检有助于AIP的诊断；结合血清学检查、其他器官受累及激素实验性治疗能提高AIP的正确诊断率；增加激素剂量或联合其他免疫抑制剂能有效治疗复发；当大剂量激素引起并发症时，应进行小剂量激素治疗。

关键词: 自身免疫性胰腺炎, IgG4, 激素实验性治疗

Abstract:

Autoimmune pancreatitis: A clinical analysis of 25 cases        TANG Neng，LUO Dong，LIU Guo-dong，et al. Department of General Surgery, Xiangya Hospital Central South University，Changsha 410000，China
Corresponding author: LI Yi-xiong，E-mail：Liyixiong2011@hotmail.com
Abstract    Objective    To summarize the clinical characteristics of autoimmune pancreatitis （ AIP） and the experience in diagnosis and treatment of  this disease. Methods    The clinical data of 25 patients with AIP are hospitalized in Xiangya Hospital of  Central South University  from September 2012 to November 2016 were retrospectively analyzed.  Results    The ratio of male with female was 2.6∶1 with median age of onset of  54 years old in these 25 patients; Their common symptoms were jaundice in 15 cases （60.0%），and abdominal pain in 11 cases （44.0%）. Fifteen cases （60.0%） were associated with other autoimmune diseases. Twenty-three  cases were detected in CA199， significantly increased （>100U/ ml） only 3 cases （13.0%）; Ninteen cases were detected in  IgG，increased in 17 cases （89.5%）; Twelve cases were detected  in IgG4 ，positive in 11 cases （91.7%）. Twenty-three cases finished CT scanning , 14 cases （60.9%） considered AIP， 12 cases did  MRCP examination，6 cases （50.0%） considered AIP. Eleven cases of therapy without steroid，14 cases of  steroid therapy. All of them were followed up for 2 to 50 months (median follow-up time of 24 months)，11（78.6%） cases steroid therapy were effective. Conclusion    The histological biopsy of the involvement organs will be helpful for the diagnosis of AIP; combined with serology examination，other organ involvement and steroid experimental therapy can improve the correct diagnosis of AIP；Increasing the dose of steroid or uniting  other immunosuppressive can be effective on therapy relapse patients；Low dose steroid  therapy should be performed when complications arise from a high dose of steroid.

Key words: autoimmune pancreatitis（AIP）, immunoglobulin G4（IgG4）, steroid experimental therapy