1型自身免疫性胰腺炎复发的相关危险因素研究

Factors associated with recurrence of type 1 autoimmune pancreatitis

背景自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是一种良性高复发性特殊类型的胰腺炎,其复发相关的危险因素尚无定论。目的探索1型自身免疫性胰腺炎复发的相关危险因素,旨在为临床诊疗提供依据。方法回顾性分析2012-2020年解放军总医院收治的有完整随访资料的103例AIP患者临床资料,分析与复发相关的影响因素。结果103例1型AIP患者中,男性79例,女性24例,平均年龄61.4±10.6(范围:29~85)岁｡中位随访时间为56(范围:24~128)个月,其中48.5%(50/103)的病例出现复发;单因素分析显示,腮腺受累(P=0.032)、血清IgG4>1140 mg/dL(P=0.014)、血清IgG>1945 mg/dL(P=0.033)、血清γ球蛋白>26.9%(P=0.028)、维持治疗(P=0.005)在两组间的差异有统计学意义。多因素分析显示,血清IgG4>1140 mg/dL(OR=2.156)、接受维持治疗(OR=0.642)等因素与1型AIP复发独立关联(P<0.05)。其中接受维持治疗是保护性因素。结论初诊时血清IgG4>1140 mg/dL是1型AIP复发的独立关联因素,而接受小剂量激素维持治疗能够减少复发。

Background Autoimmune pancreatitis(AIP)is a special type of benign and highly recurrent pancreatitis,and its risk factors for recurrence have not been established.Objective To explore the risk factors for recurrence of type 1 AIP,so as to raise the clinical awareness of diagnosis and treatment.Methods Clinical data about 103 patients with AIP admitted to Chinese PLA General Hospital from 2012 to 2020 with complete follow-up data were retrospectively analyzed.Univariate and multivariate analysis were performed to find potential risk factors and protective factors for recurrence.Results Of the 103 patients with type 1 AIP,79 cases were male and 24 cases were female,with a mean age of 61.4±10.6(range:29-85)years.The median follow-up was 56(range:24-128)months,with relapse occurring in 48.5%(50/103)of cases.Univariate analysis showed that parotid involvement(P=0.032),serum IgG4>1140 mg/dL(P=0.014),serum IgG>1945 mg/dL(P=0.033),serum gamma globulin>26.9%(P=0.028),and maintenance treatment(P=0.005)had statistically significant differences between the two groups.Results of multifactorial analysis showed that serum IgG4>1140 mg/dL(OR=2.156),receiving maintenance therapy(OR=0.642)were independently associated with type 1 AIP recurrence(P<0.05).Among them,receiving maintenance therapy was a protective factor.Conclusion Serum IgG4>1140 mg/dL at diagnosis is an independent risk factor for recurrence of type 1 AIP,and low-dose glucocorticoids maintenance therapy can reduce recurrence.