以糖尿病酮症酸中毒伴腹痛为首发症状的自身免疫性胰腺炎一例报道并文献复习

Autoimmune Pancreatitis with Diabetic Ketoacidosis and Abdominal Pain as the Initial Presentations:One Case Report and Literature Review

本文报道了1例以糖尿病酮症酸中毒(DKA)伴腹痛为首发症状的自身免疫性胰腺炎病例。该例患者以DKA为首发症状,且在DKA纠正后仍存在腹痛及胰酶、炎症指标、CA19-9升高,经影像学检查明确诊断为自身免疫性胰腺炎。患者经糖皮质激素治疗后胰腺肿胀减轻,胰酶、炎症指标、CA19-9恢复至参考范围,血糖改善。提示临床医生需要强化糖尿病分型诊断的意识,尤其是在腹痛症状持续存在、肝酶或胰酶持续升高的患者中,需进一步明确其血糖升高的病因,影像学检查有助于自身免疫性胰腺炎的确诊,及时诊断、早期使用糖皮质激素有助于改善自身免疫性胰腺炎合并糖尿病患者的预后。

This study reported a case of autoimmune pancreatitis who initially presented with diabetic ketosis and abdominal pain.Interventions were first given to him to improve DKA symptoms,but his abdominal pain remained after the relief of DKA,complicated with elevation of pancreatic enzymes,inflammatory indicators,and tumor marker CA19-9.Imaging examination confirmed the diagnosis of autoimmune pancreatitis.His pancreas swelling was reduced after glucocorticoid treatment,along with pancreatic enzymes,inflammatory indicators,and CA19-9 returned to normal level,and improvement of blood sugar.This suggests that the concern of classification diagnosis of diabetes should be strengthened,in particularly for patients with persistent abdominal pain symptoms and continuous elevation of liver or pancreatic enzymes,whose cause of elevated plasma glucose needs to be further clarified.Imaging examination favors autoimmune pancreatitis diagnosis.Early diagnosis and corticosteroids administration help to improve the prognosis of patients suffering autoimmune pancreatitis complicated with diabetes.