中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
1期
20-23
,共4页
吴文川%姚秀忠%靳大勇%王单松%楼文晖%秦新裕
吳文川%姚秀忠%靳大勇%王單鬆%樓文暉%秦新裕
오문천%요수충%근대용%왕단송%루문휘%진신유
胰腺炎%自身免疫疾病%高丙种球蛋白血症%诊断
胰腺炎%自身免疫疾病%高丙種毬蛋白血癥%診斷
이선염%자신면역질병%고병충구단백혈증%진단
Pancreatitis%Autoimmune diseases%Hypergammaglobulinemia%Diagnosis
目的 筛选可识别自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的哨兵指标,降低恶性肿瘤的误诊率.方法 回顾性分析4年来中山医院普外科住院治疗的AIP相关的病例共14例.所有患者都进行肝功能、CA199以及增强CT和(或)MRI的常规检查,临床上疑似AIP或者病理已证实AIP者,则进行IgG或IgG4的检测.比较研究AIP患者与非AIP患者之间临床特征的区别.结果 10例患者最终确诊为AIP.AIP患者CA199可以是正常或轻度升高,低于非AlP患者CA199的数值(P=0.041).所有AIP患者的血清γ球蛋白比例均升高,而非AIP患者仅有25％出现γ球蛋白升高,差异有统计学意义(P=0.011).AIP患者的IgG、IgG4升高比例均为100％,而非AIP患者分别为25％ (P =0.024)和0％(P=0.048).结论 高γ球蛋白血症是术前识别AIP的哨兵指标.拟诊胰腺癌患者若出现γ球蛋白比例升高,可进一步检查血清IgG或IgG4,以识别AIP,避免不必要的手术治疗.
目的 篩選可識彆自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的哨兵指標,降低噁性腫瘤的誤診率.方法 迴顧性分析4年來中山醫院普外科住院治療的AIP相關的病例共14例.所有患者都進行肝功能、CA199以及增彊CT和(或)MRI的常規檢查,臨床上疑似AIP或者病理已證實AIP者,則進行IgG或IgG4的檢測.比較研究AIP患者與非AIP患者之間臨床特徵的區彆.結果 10例患者最終確診為AIP.AIP患者CA199可以是正常或輕度升高,低于非AlP患者CA199的數值(P=0.041).所有AIP患者的血清γ毬蛋白比例均升高,而非AIP患者僅有25％齣現γ毬蛋白升高,差異有統計學意義(P=0.011).AIP患者的IgG、IgG4升高比例均為100％,而非AIP患者分彆為25％ (P =0.024)和0％(P=0.048).結論 高γ毬蛋白血癥是術前識彆AIP的哨兵指標.擬診胰腺癌患者若齣現γ毬蛋白比例升高,可進一步檢查血清IgG或IgG4,以識彆AIP,避免不必要的手術治療.
목적 사선가식별자신면역성이선염(autoimmune pancreatitis,AIP)적초병지표,강저악성종류적오진솔.방법 회고성분석4년래중산의원보외과주원치료적AIP상관적병례공14례.소유환자도진행간공능、CA199이급증강CT화(혹)MRI적상규검사,림상상의사AIP혹자병리이증실AIP자,칙진행IgG혹IgG4적검측.비교연구AIP환자여비AIP환자지간림상특정적구별.결과 10례환자최종학진위AIP.AIP환자CA199가이시정상혹경도승고,저우비AlP환자CA199적수치(P=0.041).소유AIP환자적혈청γ구단백비례균승고,이비AIP환자부유25％출현γ구단백승고,차이유통계학의의(P=0.011).AIP환자적IgG、IgG4승고비례균위100％,이비AIP환자분별위25％ (P =0.024)화0％(P=0.048).결론 고γ구단백혈증시술전식별AIP적초병지표.의진이선암환자약출현γ구단백비례승고,가진일보검사혈청IgG혹IgG4,이식별AIP,피면불필요적수술치료.
Objective To determine the clinical value of hypergammaglobulinemia as a sentinel for autoimmune pancreatitis and avoid unnecessary pancreas resection.Methods All 14 patients with autoimmune pancreatitis or related pancreatic diseases underwent routine examinations,including liver function,CA199 and imaging.Measurement of serum IgG or IgG4 was performed for patients with clinically suspected or pathologically proved autoimmune pancreatitis.Clinical features were retrospectively compared between the AIP and non-AIP patients using x2 statistics with Yates correction or Fisher exact test.Results Ten cases were finally confirmed as autoimmune pancreatitis.All patients with autoimmune pancreatitis had elevated levels of serum γ-globulins,while only one case without autoimmune pancreatitis had elevated levels of serum γ-globulins.It was proved by subsequent antibody tests that serum IgG/IgG4 and γ-globulins were simultaneously increased.Conclusions Hypergammaglobulinemia can be used as a preoperative sentinel indicator for differentiating autoimmune pancreatitis from pancreatic malignancies and avoiding unnecessary pancreas operation.
