CAJ | 학술논문

目的探讨自身免疫性胰腺炎(AIP)不同诊断标准间诊断情况的差异及其主要影响因素,为AIP临床诊治提供指导.方法回顾性分析解放军总医院2008年6月-2013年1月收治的561例慢性胰腺炎住院患者的临床资料,对比以美国HISORt标准及亚洲标准诊断AIP的情况,分析两者AIP诊断率差异的产生原因.结果符合2006年美国HISORt标准的AIP患者共34例,其中满足组织学诊断标准、胰腺典型影像学表现+血清IgG4升高诊断标准、激素治疗有效+血清IgG4升高诊断标准的病例数分别为5、10和26例,同时符合后两组标准者7例.符合2008年亚洲诊断标准的AIP患者共15例,其中满足两条必备影像学标准者10例,满足手术切除后病理为淋巴浆细胞硬化性胰腺炎标准者5例.结论 AIP是一种以自身免疫性炎症为特征的特殊类型的慢性胰腺炎,临床上易误诊为胰腺癌、胆管癌等.不同诊断标准相继推出,2008年亚洲诊断标准更适合我国临床实践,在血清学指标、病理结果及试验性糖皮质激素治疗等诊断方法基础上,应充分重视影像学检查对AIP诊断的重要性.
목적 탐토자신면역성이선염(AIP)불동진단표준간진단정황적차이급기주요영향인소,위AIP림상진치제공지도.방법 회고성분석해방군총의원2008년6월-2013년1월수치적561례만성이선염주원환자적림상자료,대비이미국HISORt표준급아주표준진단AIP적정황,분석량자AIP진단솔차이적산생원인.결과 부합2006년미국HISORt표준적AIP환자공34례,기중만족조직학진단표준、이선전형영상학표현+혈청IgG4승고진단표준、격소치료유효+혈청IgG4승고진단표준적병례수분별위5、10화26례,동시부합후량조표준자7례.부합2008년아주진단표준적AIP환자공15례,기중만족량조필비영상학표준자10례,만족수술절제후병리위림파장세포경화성이선염표준자5례.결론 AIP시일충이자신면역성염증위특정적특수류형적만성이선염,림상상역오진위이선암、담관암등.불동진단표준상계추출,2008년아주진단표준경괄합아국림상실천,재혈청학지표、병리결과급시험성당피질격소치료등진단방법기출상,응충분중시영상학검사대AIP진단적중요성.
Objective To discuss the difference in diagnostic criteria of autoimmune pancreatitis (AIP) and its major influential factors,so as to provide guidance for AIP diagnosis and treatment.Methods The clinical data of 561 cases of chronic pancreatitis admitted to PLA General Hospital from June,2008 to January,2013 were retrospectively reviewed and analyzed.Data were extracted and analyzed to summarize the reasons of the differences in AIP diagnosis rate diagnosed by different diagnostic criteria.Results A total of 34 cases were eligible for the 2006 American HISORt criteria of AIP of whom,5,10 and 26 met the criteria of histology,pancreatic imaging findings and increasing serum IgG4 levels,and response to steroids and increasing serum IgG4 levels,respectively.Seven AIP patients met the latter two criteria.Fifteen patients were eligible for the 2008 Asian diagnostic criteria for AIP,of which,10 met the two necessary imaging findings and 5 met the criteria of pathology of lymphoplasmacytic sclerosing pancreatitis(LPSP) after surgical resection.Conclusions AIP is characterized by autoimmune inflammatory process,and is easy to be misdiagnosed as pancreatic cancer or cholangiocarcinoma etc.As a few sets of criteria issued from different countries,the 2008 Asian diagnostic criterion is more suitable with Chinese population.We should pay full attention to the importance of imaging examination of the diagnosis of AIP on the base of the detection of immune parameters,pathological examination and response to steroids.