自身免疫性胰腺炎22例临床诊治分析

Clinical analysis of 22 cases of autoimmune pancreatitis

目的探索自身免疫性胰腺炎(AIP)的临床特点及诊疗方法。方法回顾性分析2017年9月至2020年7月在复旦大学附属中山医院胰腺外科诊治的22例AIP病人临床资料。通过记录分析AIP病人初诊及治疗阶段的临床表现,血清IgG4变化情况等辅助检查结果,激素治疗等情况,探索其诊治策略。结果病人最初就诊时血清IgG4中位数为5.56(0.34~30.30)g/L,其中单纯胰腺受累者2.52(0.34~5.73)g/L,合并其他器官受累者7.59(0.66~30.30)g/L,合并胰腺外器官受累的AIP病人IgG4水平高于单纯胰腺受累的AIP病人(Z=5.693,P=0.045);22例病人中有9例接受激素治疗,治疗期间IgG4水平3.7(0.99,18.3)g/L,激素治疗2个月后IgG4水平中位数1.63(0.76,8.31)g/L,较未行激素治疗时明显下降(Z=-2.093,P=0.038)。8例病人(激素治疗5例,未激素治疗3例)复发时,IgG4较前均有不同程度升高(8/8,100%),中位升高数值4.14(0.61,14.81)g/L;4例停药病人中,2例病人IgG4水平未恢复到正常(2/4,50%)。另有13例病人未接受激素治疗,治疗随访时10例(10/13,76.9%)病人处于临床缓解期。结论在AIP病人中,血清IgG4在多器官受累时升高更为显著。使用激素治疗的AIP病人,开始激素治疗2个月后,复测IgG4较治疗前显著降低。部分轻症的AIP病人,经对症治疗后,可自行缓解。

ObjectiveTo explore the diagnosis and treatment of autoimmune pancreatitis through the clinical features.MethodsThe clinical data of 22 AIP patients treated in Department of Pancreas Surgery,Zhongshan Hospital,FudanUniversity from September 2017 to July 2020 were analyzed retrospectively.By recording and analyzing the clinicalmanifestations of AIP patients at the initial diagnosis and treatment stage,the changes of serum Ig G4 and other auxiliaryexamination results,steroids therapy and other conditions,the diagnosis and treatment strategies were explored.Results At the initial consultation,serum Ig G4 was 5.56(0.34 to 30.30)g/L,including 2.52(0.34 to 5.73)g/L for patients withpancreatic involvement alone and 7.59(0.66 to 30.30)g/L for patients with other organs involvement.The Ig G4 level ofAIP patients with other organs involvement was higher than that of AIP patients with pancreatic involvement alone(Z=5.693,P=0.045).Nine of 22 patients received steroids therapy,and the Ig G4 level median was 3.7(0.99,18.3)g/L duringthe treatment.After 2 months of steroids therapy,the Ig G4 level median was 1.63(0.76,8.31)g/L,which was significantlylower than that before steroids treatment(Z=-2.093,P=0.038).Eight patients had AIP relapse(5 with steroids therapyand 3 without steroids therapy).Ig G4 was totally increased(8/8,100%),increased by 4.14(0.61,14.81)g/L on median.The Ig G4 level did not return to normal in 2 of the 4 patients(2/4,50%)who discontinued steroids therapy.Another 13 patients did not receive steroids therapy,and 10 patients(10/13,76.9%)were in clinical remission at the time of follow-up.ConclusionSerum Ig G4 increase more significantly when other organs are involved in AIP.Ig G4 is significantly decreased after 2 months of steroids therapy in AIPpatients.Observation and follow-up of mild AIPpatients after symptomatic treatment are alsotreatment strategy.