自身免疫性胰腺炎的临床诊治分析

Clinical diagnosis and treatment of autoimmune pancreatitis

目的探讨自身免疫性胰腺炎(AIP)的临床表现、诊断鉴别和治疗。方法回顾性分析苏州大学第一附属医院2021年4月至2023年1月收治的17例AIP患者的临床资料。结果17例AIP患者中,12例为男性(70.6%)。10例主诉腹痛(58.8%),8例黄疸(47.1%)。15例IgG4水平升高且超过正常值的2倍以上(88.2%),14例伴肝酶升高(82.3%)。17例患者影像学表现均为胰腺弥漫性或局限性肿大,部分伴有胰管或胆管的扩张。14例患者结合临床表现、影像学检查、实验室检查、穿刺病理确诊,3例术后病理证实。14例患者应用激素治疗后临床症状、影像学表现明显好转,2例患者影像学好转后自行停药,其中1例复发,再次应用激素有效。结论AIP累及胰腺导致炎症反应,累及胆管可引起胆道狭窄继而出现黄疸,糖皮质激素对大多数患者治疗效果良好。

Objective To investigate the clinical manifestations,diagnosis and treatment of autoimmune pancreatitis(AIP).Methods The clinical data of 17 AIP patients admitted at the First Affiliated Hospital of Soochow University from Apr 2021 to Jan 2023 were retrospectively analyzed.Results Among the 17 AIP patients,12 were male(70.6%).Ten complained abdominal pain(58.8%),and 8 had jaundice(47.1%).Fifteen patients had elevated IgG4 levels more than twice the normal value(88.2%),and 14 patients had elevated liver enzymes(82.3%).The imaging manifestations of 17 patients were all diffuse or limited enlargement of the pancreas.All patients had diffuse or limited enlargement of the pancreas,some were accompanied by a dilatation of the pancreatic duct or bile duct.Fourteen patients were diagnosed by combining the clinical manifestations,imaging examination,laboratory examination,and puncture pathology,and in 3 cases the diagnosis was confirmed by postoperative pathology.Fourteen patients showed significant improvement in clinical symptoms and imaging manifestations after hormone therapy,2 patients stopped hormone medication on their own after the improvement of the imaging,and 1 suffered recurrence,which was responsible to hormone readministration.Conclusions AIP,as a rare and easily misdiagnosed immune disease,involves the pancreas leading to an inflammatory response and often encroaches peri-pancreatic areas such as the bile ducts,causing biliary stenosis and jaundice.Most patients respond well to glucocorticoid therapy and surgery was usually not indicated in those with definite AIP diagnosis.