CAJ | 학술논문

目的总结并探讨自身免疫性胰腺炎(AIP)的临床特征及其诊断与治疗.方法回顾性分析北京协和医院2003年3月至2008年1月确诊的16例AIP患者资料.结果 AIP患者以男性居多,男∶女为15∶1,平均年龄61岁(47～79岁).81.2%的患者以黄疸为主要临床表现.68.8%的患者有高γ球蛋白血症,66.7%血IgG增高,56.2%红细胞沉降率增快,50.0%类风湿因子阳性,43.7%嗜酸粒细胞升高,26.7%抗核抗体阳性,31.2%血清脂肪酶升高,18.7%血淀粉酶一过性升高,25.0%CA19-9升高.腹部CT和(或)内镜超声(EUS)示93.7%患者的胰腺弥漫性肿大,100%胰管狭窄、87.5%合并胆总管胰腺段狭窄,50.0%胆管壁增厚.EUS下穿刺活检6例,1例无结果,5例均未见肿瘤细胞;3例见淋巴细胞浸润;2例有胰腺纤维化.75.0%合并糖尿病或糖耐量异常,43.7%见腹腔淋巴结肿大,42.9%有脾静脉或下腔静脉受累,18.7%合并泪腺肿大,12.5%合并颌下腺肿大.11例应用泼尼松治疗(其中7例同时胆总管支架置入),10例效果良好,1例因不耐受而停用;2例单纯行胆总管支架置入术,黄疸解除;3例仅对症治疗.激素对糖尿病患者血糖水平影响不一,泪腺与颌下腺肿大者在激素治疗后迅速消肿.结论 AIP好发于中老年男性,多以无痛性、梗阻性黄疸首诊.可有血清IgG和球蛋白升高,抗核抗体和类风湿因子阳性.影像学见胰腺弥漫或局限性肿大、胰管狭窄、胆总管胰腺段狭窄.激素治疗有效,支架植入可缓解症状.
목적 총결병탐토자신면역성이선염(AIP)적림상특정급기진단여치료.방법 회고성분석북경협화의원2003년3월지2008년1월학진적16례AIP환자자료.결과 AIP환자이남성거다,남∶녀위15∶1,평균년령61세(47～79세).81.2%적환자이황달위주요림상표현.68.8%적환자유고γ구단백혈증,66.7%혈IgG증고,56.2%홍세포침강솔증쾌,50.0%류풍습인자양성,43.7%기산립세포승고,26.7%항핵항체양성,31.2%혈청지방매승고,18.7%혈정분매일과성승고,25.0%CA19-9승고.복부CT화(혹)내경초성(EUS)시93.7%환자적이선미만성종대,100%이관협착、87.5%합병담총관이선단협착,50.0%담관벽증후.EUS하천자활검6례,1례무결과,5례균미견종류세포;3례견림파세포침윤;2례유이선섬유화.75.0%합병당뇨병혹당내량이상,43.7%견복강림파결종대,42.9%유비정맥혹하강정맥수루,18.7%합병루선종대,12.5%합병합하선종대.11례응용발니송치료(기중7례동시담총관지가치입),10례효과량호,1례인불내수이정용;2례단순행담총관지가치입술,황달해제;3례부대증치료.격소대당뇨병환자혈당수평영향불일,루선여합하선종대자재격소치료후신속소종.결론 AIP호발우중노년남성,다이무통성、경조성황달수진.가유혈청IgG화구단백승고,항핵항체화류풍습인자양성.영상학견이선미만혹국한성종대、이관협착、담총관이선단협착.격소치료유효,지가식입가완해증상.
Objective To summarize the clinical features, diagnosis and treatment of autoimmune pancreatitis (AIP). Methods From March 2003 to January 2008, a total of 16 cases of AIP were reviewed retrospectively. Results The ratio of male: female was 15:1, with a mean age of 61 years old (range:47-79 years old). Jaundice was the main clinical presentation in 81.2% patients. 68.8% patients presented with high serum gammaglobulin, while 66.7% with high serum IgG, 56.2% with elevated ESR, 50.0% with positive rheumatoid factor(RF), 43.7% with eosinophilia, 26.7% with positive antinuclear antigen(ANA),31.2% with elevated lipase, 18.7% with elevated amylase, and 25.0% with elevated CA19-9. 93.7%patients showed diffuse swelling of the pancreas on CT and/or endoscopic ultrasound. Stricture of the main pancreatic duct was seen in 100% patients. Distal common bile duct stricture was seen in 87.5%, while thickened wall of bile duct was seen in 50%. Histological findings of the pancreas EUS-FNA showed nonspecific results in one patient, while no tumor cell was detected in other 5 patients; lymphocytes infiltration was noted in 3 patients; pancreatic fibrosis was seen in 2 patients. 75.0% patients was found to have diabetes or abnormal sugar tolerance, enlargement of the celiac lymph nodes in 43.7%, splenic vein or inferior cava vein involvement in 42.9%, swelling of the maxillary glands in 18.7%, the lacrimal glands in 12%. Prednisone was given to 11 patients, among them 5 patients underwent endoscopic stent placement, and 10 patients responded well while 1 patient discontinued therapy due to intolerance. 2 patients underwent endoscopic stent placement alone and jaundice disappeared. 3 patients received conventional medical treatment. Steroid therapy exerted different effects on levels of the blood glucose, the enlarged maxillary and lacrimal glands improved after steroid therapy. Conclusions AIP occurred in middle aged and senior male predominantly, painless obstructive jaundice was the main clinical presentation, and patients may be accompanied with elevated levels of IgG, hypergammaglobulin, positive RF and ANA, diffuse or focal pancreatic enlargement, pancreatic duct stricture and distal common bile duct stricture. Stent placement could improve the symptoms, and steroid therapy was effective.