CAJ | 학술논문

目的探讨自身免疫性胰腺炎(AIP)激素治疗的远期疗效、预后及激素治疗的给药方法.方法分析2004年8月至2008年8月北京协和医院确诊并随访的13例AIP患者临床资料.结果 13例AIP患者中男12例、女1例,平均年龄58.7岁,平均随访30个月.合并胆管病变11例,其中9例放置胆管支架且均已取出.11例患者接受激素治疗,平均起始剂量为每日0.6 mg/kg.10例患者临床治愈,已停用激素,平均激素治疗时间为9.2个月,其中6例联合胆管支架置入者平均激素治疗时间为7.9个月,4例单纯激素治疗者则为13.4个月,差异有统计学意义(P=0.023).激素治疗后患者各血清学指标于5.3～8.8周内恢复正常.经激素治疗后第1次影像学复查时(1.0～11.3周)患者胰腺肿大均获改善,9例患者平均经16.6周激素治疗后胰腺大小恢复正常.随访期间所有患者无影像学胰腺炎复发表现.8例合并新发糖尿病的患者经激素治疗后4例血糖恢复正常.2例合并自身免疫性肝病患者随访结束时出现早期肝硬化表现.1例患者在停用激素6个月时颌下腺肿大复发.结论 AIP患者对激素治疗反应良好,放置胆管支架可缩短激素治疗时间,合并胆管病变及新发糖尿病者在激素治疗后部分可获缓解,但合并自身免疫性肝病者预后相对较差.
목적 탐토자신면역성이선염(AIP)격소치료적원기료효、예후급격소치료적급약방법.방법 분석2004년8월지2008년8월북경협화의원학진병수방적13례AIP환자림상자료.결과 13례AIP환자중남12례、녀1례,평균년령58.7세,평균수방30개월.합병담관병변11례,기중9례방치담관지가차균이취출.11례환자접수격소치료,평균기시제량위매일0.6 mg/kg.10례환자림상치유,이정용격소,평균격소치료시간위9.2개월,기중6례연합담관지가치입자평균격소치료시간위7.9개월,4례단순격소치료자칙위13.4개월,차이유통계학의의(P=0.023).격소치료후환자각혈청학지표우5.3～8.8주내회복정상.경격소치료후제1차영상학복사시(1.0～11.3주)환자이선종대균획개선,9례환자평균경16.6주격소치료후이선대소회복정상.수방기간소유환자무영상학이선염복발표현.8례합병신발당뇨병적환자경격소치료후4례혈당회복정상.2례합병자신면역성간병환자수방결속시출현조기간경화표현.1례환자재정용격소6개월시합하선종대복발.결론 AIP환자대격소치료반응량호,방치담관지가가축단격소치료시간,합병담관병변급신발당뇨병자재격소치료후부분가획완해,단합병자신면역성간병자예후상대교차.
Objective To explore the long-term effect, prognosis and administration of corticosteroid treatment on autoimmune pancreatitis (AIP). Methods Clinical data were analyzed in 13 diagnosed and followed up AIP patients of Peking Union Medicine College Hospital during August 2004 to August 2008. Results Of 13 patients, 12 were males and 1 was female, with a mean age of 58.7 years old, and a mean follow-up of 30 months. Of 11 patients compliated with bile duct disease,biliary stents were placed in 9 patients and already taken out. Corticosteroid treatment was received by cured patients. The average corticosteroid therapeutic time was 9.2 months, 7.9 months in 6 biliary stent placed patients, 13.4 months in corticosteroid treated alone patients, the statistical difference was significant (P = 0. 023). Serum inflammatory parameters normalized range from 5. 3 to 8.8 weeks. After corticosteroid treatment, pancreas enlargement improved in all patients at the first imaging reexamination (1.0 to 11.3 weeks), pancreatic size normalized in 9 patients with an average of 16.6 weeks corticosteroid treatment. No relapsing sign was found with imaging examination during follow-up. Of 8 newly onset diabetes patients, glucose level normalized in 4 patients after corticosteroid treatment. Two patients complicated with autoimmune hepatitis developed early hepatic cirrhosis symptoms at the end of the follow-up. Swollen submandibular gland enlargement relapsed in one patient after corticosteroid withdrawn for six months. Conclsion AIP patients responsed well to corticosteroid treatment. Placement of biliary stent could shorten corticosteroid therapeutic time.Patients with bile duct complications and newly onset diabetes could partially relieve after the corticosteroid treatment, the prognosis of patients with autoimmune hepatitis complications was relatively poor.