自身免疫性胰腺炎32例临床分析  

The clinical characteristics of 32 patients with autoimmune pancreatitis

作　　者：陈冻伢 曹红艳 陈钰[1] 历有名[1] 虞朝辉[1] 

机构地区：[1]浙江大学医学院附属第一医院,杭州310003 [2]浙江省青春医院

出　　处：《中华内科杂志》2014年第5期380-383,共4页Chinese Journal of Internal Medicine

摘　　要：目的 总结自身免疫性胰腺炎（AIP）的临床特征.方法 回顾性分析2009年11月-2013年4月浙江大学医学院附属第一医院收治的32例AIP患者的临床资料.结果 32例患者中,男25例,女7例;年龄27 ～ 84（62.5±12.6）岁;初发表现为梗阻性黄疸（50.0％,16/32）、腹痛（43.8％,14/32）、乏力消瘦（12.5％,4/32）、血便（6.3％,2/32）、肝功能异常（6.3％,2/32）、球蛋白升高（71.9％,23/32）、IgG升高（70.4％,19/27）、IgG4升高（8/10）、CA19-9升高（59.4％,19/32）;62.5％（20/32）患者CT和/或B超示胰腺弥漫性肿大,37.5％ （12/32）为局灶性肿大,62.5％（20/32）为主胰管狭窄.19例获得组织病理,显示胰腺间质纤维组织增生,淋巴细胞、浆细胞浸润.结论 AIP是一种较易误诊为胰腺癌的自身免疫病,通过临床特征、实验室血清学指标、影像学特点、典型的组织病理表现以及糖皮质激素治疗有效等可获确诊.Objective To explore the clinical characteristics and diagnosis of autoimmune pancreatitis（AIP） with the aim to raise awareness of AIP.Methods Clinical data of 32 patients with AIP were retrospectively analyzed,including clinical manifestations,imaging features,laboratory examination,histopathology and treatment from November 2009 to April 2013 in the First Affiliated Hospital of Medical School,Zhejiang University.Results All 32 AIP patients including 25 males and 7 females had a median age of （62.5 ± 12.6） years （27-84 years）.The initial symptoms included obstructive jaundice in 50.0％patients （16/32）,abdominal pain in 43.8％ （14/32）,fatigue and weight loss in 12.5％ （4/32）,and bloody stool in 6.3％ （2/32）.Laboratory findings revealed abnormal liver function in 6.3％ （2/32）patients,increased immunoglobulins in 71.9％ （23/32）patients and elevated IgG4 in 8/10 patients.Computerized tomography（CT） scan and ultrasonography were performed in all patients.Diffusely enlarged pancreas were found in 62.5％ （20/32） patients and focally enlarged in 37.5％ （12/32）,additionally main pancreatic duct stenosis in 62.5％ （20/32） patients.Nineteen patients obtained histopathological examination,indicating pancreatic interstitial fibrosis,and infiltration of lymphocytes and plasma cells.Conclusions Autoimmune pancreatitis is an autoimmune disease which may be misdiagnosed as pancreatic cancer.The clinical features,laboratory findings,imaging characteristics,and typical histopathologic presentation,as well as good response to glucocorticoids provide supportive evidence for the diagnosis of AIP.

关 键 词：自身免疫疾病 胰腺炎 诊断 临床特征 

分 类 号：R576[医药卫生—消化系统]