自身免疫性胰腺炎(附5例报告)

Autoimmune pancreatitis(report of 5 cases)

目的：分析自身免疫性胰腺炎（autoimmune pancreatitis，AIP）患者的影像学表现、临床特征、血清学检查及病理学结果。方法：从2004年12月-2008年11月，回顾分析了5例AIP病例，其中3男2女，平均年龄为58．2岁（范围：54～65岁）。诊断标准符合Kim标准及修订的日本标准。结果：5名AIP患者的临床表现包括：黄疸（5／5）、腹痛（2／5）及糖尿病（3／5）。实验室检查：2名患者血沉增快；3名患者IgG水平升高；4名患者CA19．9升高。CT表现：胰腺弥漫肿大（4／5）或胰头肿块（1／5）；MRCP表现：胆总管下段狭窄（5／5）；ERCP表现：主胰管弥漫性狭窄和胆总管局限性狭窄。4名患者因怀疑胰腺癌而进行了开腹探查手术，此4名患者的病理表现为AIP特征性的胰腺淋巴浆细胞浸润及纤维化。2名患者接受了糖皮质激素治疗，胰腺肿大减轻。其中1名患者在激素减量过程中复发，再次给予激素治疗后2次好转。结论：AIP的影像学表现具有一定特征性。综合分析其影像学表现、临床症状、血清学检查及对激素治疗的反应等因素可以对AIP作出早期正确诊断，以避免不必要的开腹手术。

Objective：Analysis the imaging features, clinical appearances, serum and histologic characteristics of autoimmune pancreatitis （ALP）. Methods：There are 5 cases of AlP from December 2004 to November 2008 have been reviewed retrospectively. 3 male and 2 female patients, average age is 58.2 years old （range： 54 - 65 years）. Diagnostic criteria accord with the Kim et al Criteria and the Revised Japan Criteria. Results： Clinical appearances include jaundice （5/5）, abdominal pain （2/5） and diabetes meUitus （DM） （3/ 5）. Elevated ESR, serum IgG and CA19-9 were found in 2, 3, and 4 cases, respectively. CT presents diffuse enlargement （4/5） or focal mass （1/5） of pancreas. MRCP shows stricture of distal common bile duct （5/5）. ERCP presents diffuse irregular strictures of main pancreatic duct and focal stricture of common bile duct. Open surgery in 4 patients and histologic results are characteristic lymphoplasmaeyrie infiiltration and fibrosis of pancreas. Steroid therapy in 2 patients, both had obvious responses to steroid medicine. One case recurred and turned better again given steroid therapy. Conclusion： There are characteristic imaging features of AIP. The accurate diagnosis of AIP based on imaging features, clinical appearances, serum examinations and response to steroid therapy may help to avoid urmecessary surgery.