自身免疫性胰腺炎临床治疗体会

Clinical experience in the treatment of autoimmune pancreatitis

目的探讨自身免疫性胰腺炎(AIP)规律,为临床治疗提供参考。方法纳入2013年7月至2017年5月在甘肃省白银市第一人民医院诊断为AIP的13例患者,进行回顾性分析患者的临床资料。总结临床表现、症状、影像学表现、实验室检查、治疗效果、预后。结果13例AIP患者中,临床表现为皮肤巩膜黄染8例(61%),腹痛7例(54%),腹胀5例(38%),纳差5例(38%),体重下降4例(31%)。CT表现为:胰腺局限性肿大7例(54%),胰腺弥漫性肿大6例(46%)。8例MRCP表现为胆总管下段狭窄,狭窄段以上的胆管扩张,2例表现为典型的"鼠尾征"。5例均伴有硬化性胆管炎;4例伴全身多处淋巴结肿大;3例合并类风湿性关节炎;4例诊断为2型糖尿病,其中3例患者既往有2型糖尿病病史。12例患者激素治疗+熊去氧胆酸治疗,其中3例因黄疸较重行逆行胰胆管造影(ERCP),病情均好转痊愈,1例因误诊为胆管癌行手术治疗。出院后随访1~3年,平均1.5年。其中2例患者治疗依存性较差,分别于发病后3月、5月自行停药5天、10天,经随访再次劝阻复查后,再次治疗。12例均痊愈。其中2例复发,分别是治疗第8个月和17月后复发。1例于治疗后19月死亡,死亡原因为胰腺癌。结论AIP通过激素、熊去氧胆酸及ERCP,出院后的随访综合治疗,才能取得较好疗效。

Objective To explore the regularity of autoimmune pancreatitis(AIP)and provide the reference for the clinical practice.Methods From July 2013 to May 2017,we analyzed the result of treated autoimmune pancreatitis in 13 cases in Baiyin First People′s Hospital of Gansu Province.The clinical manifestation,symptom,imaging,laboratory examination,therapeutic effect,and prognosis were summarized.Results Of 13 patients,clinical presentation included cutaneous or sclera icterus in 8 cases(61%),abdominal pain in 7 cases(54%),abdominal distention in cases(38%),anorexia in cases(38%),and weight loss in 4 cases(31%).The CT showed that localized enlargement of the pancreas in7 cases(54%)and diffuse enlargement of the pancreas in 6 cases(46%).MRCP showed that stenosis of the lower part of the common bile duct and the bile duct dilatation in narrow distal segment in 8 cases,a typical"mouse-tail sign"in 2 cases,primary sclerosing cholangitis in 5 cases,a generalized lymphadenopathy in 4 cases,rheumatoid arthritis in 3 cases,and type 2 diabetes in 4 cases of,3 cases of whom had a family history of type 2 diabetes.Among 12 patients treated with hormone therapy plus ursodeoxycholic acid,3 patients obviously improved and healed after retrograde cholangiopancreatography treatment due to severe jaundice.A patient was misdiagnosed as cholangiocarcinoma and made in surgical treatment.The follow-up period was 1-3 years,after discharge.The mean follow-up period was 1.5 years.2 patients with poor dependency relapse after the onset of medicine for 5 days,10 days in March and May he onset of medicine for 5 days,10 days.after a follow-up reexamination,treatment.All 12 cases were healed and 2 patients recurred after treatment for 8 months and 17 months,respectively.One case died after treatment 19 months.The cause of death was pancreatic cancer.In order to achieve better curative effect.Conclusion AIP patients should treate with hormone,ursodeoxycholic acid,and ERCP,combined with comprehensive treatment after discharge from the hospital.