自身免疫性胰腺炎14例临床分析

Clinical analysis of autoimmune pancreatitis： a single center study of 14 consecutive cases

目的探讨自身免疫性胰腺炎（AIP）的特征性表现，以提高对其的认识程度和诊治水平。方法对2002年2月至2008年4月间收治的14例AIP患者的临床表现以及影像学、实验室、病理学资料和治疗效果进行回顾性分析，其中男性13例，女性1例，年龄35～71岁，平均53岁。临床表现为进行性皮肤巩膜黄染11例，持续性或间歇性上腹胀痛不适3例。结果CT检查表现为胰腺弥漫性肿大伴胰管弥漫性不规则狭窄11例，胰头局灶性肿大伴胰头处胰管狭窄3例，全部病例均有胆总管胰腺段狭窄。共有12例患者接受免疫球蛋白G（IgG）和自身抗体检测，其中7例IgG浓度升高，6例自身抗体阳性。14例AIP患者中，9例就诊时存在或随访中出现胰腺外其他自身免疫性疾病。病理检查显示3例胰腺导管周围有致密的淋巴细胞和浆细胞浸润伴间质纤维化。因怀疑胰腺恶性肿瘤而行手术治疗7例，给予皮质类固醇激素治疗7例，治疗结果满意。随访中有4例复发。结论AIP应该作为胰腺癌的一种鉴别诊断，避免因误诊而进行不必要的手术治疗。

Objective To investigate the characteristic findings of autoimmune pancreatitis （AIP） to increase the recognition of AIP. Methods From February 2002 to April 2008, a total of 14 cases of AIP were reviewed by clinical ,imaging, serologic ,histopathologic features and treatment response. There were 13 male and 1 female, with a mean age of 53 years. The main clinical manifestations included progressive obstructive jaundice in 11 cases, upper abdomen pain in 3 cases. Results Diffuse enlargement of pancreas and diffuse narrowing of the main pancreatic duct（MPD） were observed in 11 cases, while 3 patients showed localized pancreatic head enlargement and focal narrowing of the MPD. Distal common bile duct stenosis was found in all cases. Increased expression of serum immunoglobulin G was found in 7 patients. Autoantibody test was positive in 5 of 12 patients. Nine of 14 patients with AIP had extrapancreatic organ involvement. Massive lymphocytes and plasma cells infiltration in pancreatic tissues were showed on pathology, as well as parenchymal fibrosis. Seven earlier patiens were treated initially with surgical laparotomy or resection for suspected malignancy. Steroid therapy was given to the other patients and was responsive. There were 4 recurrences after initial treatment. Conclusion AIP should be a differential diagnosis in pancreatic head mass in order to avoid unnecessary resection.