自身免疫性胰腺炎与胰腺癌在临床症状及血清学方面的鉴别诊断研究

Differential diagnosis between autoimmune pancreatitis and pancreatic cancer on clinical symptoms and serological features

目的回顾性分析自身免疫性胰腺炎（AIP）患者及胰腺癌患者的临床症状及血清学特征，提高AIP与胰腺癌的鉴别诊断能力。方法选取2003年1月至2011年10月我院外科收治的术后病理学结果符合亚洲标准的AIP患者36例及支持胰腺癌组织病理学诊断的患者95例，总结AIP与胰腺癌在临床症状、血清学等方面鉴别诊断的特点。结果AIP与胰腺癌的鉴别特征：（1）胰腺癌患者年龄（60．9±9．0）岁高于AIP患者（53．56±14．6）岁（t=3．48，P〈0．05），AIP更倾向于男性（χ2=2．88，P〈0．05）；（2）AIP与胰腺癌的临床特征极易混淆，均有年龄特点，表现为低年龄症状相对典型，易早期发现，高年龄相对隐匿，易导致延误。（3）AIP更易合并胆系炎症（47．2％与12．6％，X。=18．12，P〈0．05），胰腺癌更易合并肝。肾囊肿（29．5％与0，χ2=13．50，P〈0．05）；（4）高滴度CAl99在诊断胰腺癌方面具有较高的价值[浓度：AIP组：20．51（9．55，86．50）kU／L，胰腺癌组：326．50（94．38，10393．00）kU／L；阳性率：AIP组：35．70％（10／28），胰腺癌组：86．70％（65／75），P=0．000]。高滴度淀粉酶[浓度：AIP组：103．50（72．00，252．00）U／L，胰腺癌组：46．50（21．65，96．90）U／L；阳性率：AIP组：45．00％（9／20），胰腺癌组：19．40％（7／36），P=0．043]、脂肪酶[浓度：AIP组：340．50（152．05，495．80）U／L，胰腺癌组：107．40（23．40，177．26）U／L，P=0．005]、天冬氨酸氨基转移酶[阳性率：AIP组：75．00％（27／36），胰腺癌组：55．90％（52／93），P=0．046]、γ-谷氨酰转肽酶[阳性率：AIP组：79．40％（27／34），胰腺癌组：57．10％（52／91），P=0。022]在诊断AIP方面具有较高的价值，CA199明显升高不是除外AIP的依据。结论AIP做为一种特殊类型的慢性胰腺炎，在临床症状及血清学方面可与胰腺癌进行鉴别诊断。

Objective To improve the different diagnosis between autoimmune pancreatitis （AIP） and pancreatic cancer（PC） by a retrospective analysis of clinical symptoms and serological features. Methods The analysis included 36 patients who had postoperative pathological, serological findings consistent with Asian AIP standards and 95 patients who had postoperative pathological consistent with PC pathological standards. All patients were admitted by the surgery department of our hospital from January, 2003 to October, 2011. A retrospective comparative analysis of the clinical manifestations,serology data of these AIP and PC patients was conducted. And summary the differential diagnosis characteristics of AIP and pancreatic cancer in the clinical symptoms, the serology. Results The features of different diagnosis ： （ 1 ） The age of patients with PC was higher than AIP（ （60. 9 ± 9.0） years vs. （53.56 ± 14. 6） years, t = 3.48, P 〈 0.05 ）, and AIP preferred to male groups （χ2 = 2. 88, P = 0. 09 ）. （ 2 ） The clinical features of AIP and PC with the age characteristics were easily confused. Both clinical features were relatively typical in younger age which could be found earlier and relatively insidious in the older age which might be found with delay. （3） AIP were often complicated by biliary system inflammations （ AIP = 47.2 % , PC = 12. 6%, χ2 = 18. 12, P 〈 0. 05 ）, while PC were usually complicated by the cysts in liver and kidney （ PC = 29. 5%, AIP = 0, χ2 = 13.50, P 〈 0. 05 ）. （4） The high titer in CA199 had a higher value in the diagnosis of PC （ concentration： group AIP = 20. 51 （9.55,86. 5 ） kU/L, group PC = 326. 50 （94. 38,10393.00） kU/L; positive rate ： group AIP = 35. 70% （ 10/28 ）, group PC = 86. 70% （ 65/75 ）, P = 0. 000）. The high titers in amylase （ concentration ： group AIP = 103.50 （72.00,252. 00） U/L, group PC = 46. 50 （21.65,96. 90） U/L; positive rate ： group AIP = 45.00% （ 9/20 ）, group PC = 19. 40% （ 7/36 ）, P = 0. 043 ）, lipase （ concentration ： group AlP = 340. 50 （ 152. 05,495. 80 ） U/L, group PC = 107. 40 （ 23.40, 177. 26 ） U/L, P = 0. 005 ; aspartate aminotransferase （ positive rate ： group AlP = 75.00% （ 27/36 ） , group, PC = 55.90% （ 52/93 ） , P = 0. 046 ） and-γ-glutamyhranspeptidase （ positive rate ： group AIP = 79.40% （ 27/34 ）, group PC = 57.10% （52/91）,P = 0. 022） had higher values in the diagnosis of AlP. The significant increases in CA199 were not the basis which excluding AlP. Conclusion AIP as a unique type of chronic pancreatitis can be distinguished from PC on distinctive clinical, serological characteristics.