185例自身免疫性胰腺炎的荟萃分析

Meta-analysis of 185 cases of autoimmune pancreatitis

目的总结自身免疫性胰腺炎临床特征与诊治经验。方法以"自身免疫性胰腺炎"为关键词,通过中国医院知识数据库、万方数据、维普数据库,检索2011年1月以前发表的文献,并进行汇总分析。结果符合Kim标准的自身免疫性胰腺炎(auto-immune pancreatitis,AIP)患者共185例,临床表现主要为间歇性或进行性黄疸、轻度腹痛、体质量减轻等。影像学特点包括胰腺肿大,尤以胰头明显,主胰管狭窄及胆总管胰腺段狭窄合并近端胆管扩张。病理检查可见胰腺组织内淋巴细胞、浆细胞浸润和实质纤维化。AIP诊断主要依赖临床表现、影像学和病理学特征。临床误诊为胰胆恶性肿瘤93例,其中85例实施手术,185例患者中127例使用糖皮质激素治疗后临床症状明显缓解。结论 AIP是一种特殊类型的慢性胰腺炎,易误诊为胰腺癌而采取手术治疗。临床医师需提高对该类疾病的认识和临床诊疗水平。

Objective To analyze and summarize the clinical characteristics of autoimmune pancreatitis （AIP） and to clarify diagnosis and treatment status of AIP in China. Methods All articles published before January 2011 in China were searched with keyword ＇ autoimmune pancreatitis＇ from the Journal Library of China Hospital Knowledge Database, Wanfang Database, Weipu Database. Data were extracted and analyzed. Results 185 patients were diagnosed as AIP according to the Kim diagnostic criteria. The main clinical manifestations were intermittent or progressive jaundice, mild epigastric pain, weight loss, etc. The imaging characteristics were pancreatic enlargement, especially in pancreatic head, strictures of main pancreatic duct and intrapanereatic common bile duct with dilation of proximal bile duct. Patho- logic examination showed that lymphocytes and plasma cells infiltration and parenchymal fibrosis in pancreatic tissues. The diagnosis of AIP relied on clinical-manifestation, imaging and pathologic characteristics. Ninety-three cases were misdiagnosed as pancreatobiliary malignancies, and eighty-five patients of them received operation. Clinical symptoms of 127 patients were relieved after receiving a treatment of glucocorticoid. Conclusion AlP is a special chronic pancreati- tis, which may be misdiagnosed as panereatma and treated by operation. Doctors should improve the ability of diagnosing and treating AIP.