自身免疫性胰腺炎不同诊断标准间诊断率的差异及其主要影响因素分析

The difference in diagnosis rate of different diagnostic criteria of autoimmune pancreatitis and its major influential factors

目的探讨自身免疫性胰腺炎（AIP）不同诊断标准间诊断情况的差异及其主要影响因素，为AIP临床诊治提供指导。方法回顾性分析解放军总医院2008年6月-2013年1月收治的561例慢性胰腺炎住院患者的临床资料，对比以美国HISORt标准及亚洲标准诊断的情况，分析两者AIP诊断率差异的产生原因。结果符合2006年美国HISORt标准的AIP患者共34例，其中满足组织学诊断标准、胰腺典型影像学表现＋血清IgG4升高诊断标准、激素治疗有效＋血清IgG4升高诊断标准的病例数分别为5、10和26例，同时符合后两组标准者7例。符合2008年亚洲诊断标准的AIP患者共15例，其中满足两条必备影像学标准者10例，满足手术切除后病理为淋巴浆细胞硬化性胰腺炎标准者5例。结论AIP是一种以自身免疫性炎症为特征的特殊类型的慢性胰腺炎，临床上易误诊为胰腺癌、胆管癌等。不同诊断标准相继推出，2008年亚洲诊断标准更适合我国临床实践，在血清学指标、病理结果及试验性糖皮质激素治疗等诊断方法基础上，应充分重视影像学检查对AIP诊断的重要性。

Objective To discuss the difference in diagnostic criteria of autoimmune pancreatitis （AIP） and its major influential factors, so as to provide guidance for AIP diagnosis and treatment. Methods The clinical data of 561 cases of chronic pancreatitis admitted to PLA General Hospital from June, 2008 to January, 2013 were retrospectively reviewed and analyzed. Data were extracted and analyzed to summarize the reasons of the differences in AlP diagnosis rate diagnosed by different diagnostic criteria. Results A total of 34 cases were eligible for the 2006 American HISORt criteria of AIP of whom, 5, 10 and 26 met the criteria of histology, pancreatic imaging findings and increasing serum IgG4 levels, and response to steroids and increasing serum IgG4 levels, respectively. Seven AIP patients met the latter two criteria. Fifteen patients were eligible for the 2008 Asian diagnostic criteria for AIP, of which, 10 met the two necessary imaging findings and 5 met the criteria of pathology of lymphoplasmaeytic sclerosing pancreatitis（LPSP） after surgical resection. Conclusions AIP is characterized by autoimmune inflammatory process, and is easy to be misdiagnosed as pancreatic cancer or cholangiocarcinoma etc. As a few sets of criteria issued from different countries, the 2008 Asian diagnostic criterion is more suitable with Chinese population. We should pay full attention to the importance of imaging examination of the diagnosis of AIP on the base of the detection of immune parameters, pathological examination and response to steroids.