自身免疫性胰腺炎的诊断与治疗  

Diagnosis and treatment of autoimmune pancreatitis

作　　者：王天龙[1] 张齐[1] 吴刚[2] 王雅玮[1] 李雪丹[3] 刘永锋[2] 

机构地区：[1]中国医科大学附属第一医院综合外科,沈阳110001 [2]中国医科大学附属第一医院肝胆外科,沈阳110001 [3]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《中华消化外科杂志》2016年第6期584-590,共7页Chinese Journal of Digestive Surgery

基　　金：基金项目：辽宁省科技厅科技攻关项目（2011225020）;沈阳市科技局科技攻关项目（F11-262-9-22）

摘　　要：目的：总结自身免疫性胰腺炎（AIP）的临床特征、诊断与治疗方法。 方法：采用回顾性描述性研究方法。收集2010年1月至2014年12月中国医科大学附属第一医院收治的43例AIP患者的临床资料。全部患者行实验室和影像学检查。对诊断明确者采取皮质类固醇激素治疗，对怀疑胰腺恶性肿瘤的患者采取手术治疗。观察指标：（1）临床表现。（2）实验室检查结果。（3）影像学表现。（4）治疗情况。（5）病理学表现。（6）随访情况。采用门诊和住院方式进行随访，随访内容包括实验室和影像学检查，随访时间截至2016年1月。偏态分布的计量资料以平均数（范围）表示。 结果：（1）临床表现：43例患者中，33例有梗阻性黄疸，19例体质量减轻，18例腹上区胀痛，5例急性轻型胰腺炎发作（同一患者合并多种症状）。43例患者中23例胰腺外组织器官受累，合并局灶性肾炎15例、干燥综合征7例、肺部受累5例、自身免疫性甲状腺炎5例、肝门部IgG4相关性胆管炎3例、腹膜后纤维化3例、溃疡性结肠炎1例（同一患者合并多种疾病）。（2）实验室检查结果：17例患者行IgG4检测，15例浓度升高。（3）影像学表现：43例患者均行腹部CT检查，胰腺弥漫性肿大、呈香肠样外观34例，胰腺局灶性肿大9例。20例患者胰周血管受累，其中包括脾静脉狭窄或闭塞，肠系膜上静脉、门静脉和脾静脉汇合部狭窄，导致区域性门静脉高压继发胃周静脉曲张和脾肿大。3例可见肠系膜上动脉被软组织肿块包绕伴大量腹腔积液。5例可见胰腺假性囊肿伴脾静脉受累和胰周渗出。15例肾脏受累的患者腹部CT检查表现为肾皮质楔形或结节样病变。 5例出现肺部炎性假瘤和间质性肺炎，肺部CT检查显示实性的肺部结节或肺泡间质弥漫性毛玻璃样斑片影。32例行MRCP检查。28例行ERCP检查，其结果Objective：To summarize the clinical characteristics, diagnosis and treatment of autoimmune pancreatitis（AIP）. Methods：The retrospective descriptive study was adopted. The clinical data of 43 patients with AIP who were admitted to the First Affiliated Hospital of China Medical University between January 2010 and December 2014 were collected. All patients underwent laboratory tests and imaging examinations. For the patients who had the definite diagnosis of AIP, corticosteroid therapy was adopted, and for the patients who had the suspicion of pancreatic cancer, surgical operation was carried out. Observed indexes included clinical manifestations, laboratory findings, imaging findings, treatment, pathological findings and followup status. The followup of imaging examinations and laboratory tests via outpatient and inpatient examinations was performed on the patients until January 2016. Measurement data with skewed distribution were presented as average （range）. Results：（1） Clinical manifestations： of the 43 patients, 33 demonstrated obstructive jaundice, 19 had loss of weight, 18 had upper abdominal pain and 5 had acute mild pancreatitis （the same patient with a variety of symptoms）. Extrapancreatic organ involvement was detected in 23 of the 43 patients, including focal nephritis in 15 patients, sicca syndrome in 7 patients, pulmonary involvement in 5 patients, autoimmune thyroiditis in 5 patients, hilar IgG4associated cholangitis in 3 patients, retroperitoneal fibrosis in 3 patients and ulcerative colitis in 1 patient （the same patient with a variety of diseases）. （2） Results of laboratory tests： 17 patients underwent serum IgG4 detection and increased expression of IgG4 was found in 15 patients. （3） Imaging findings： all the 43 patients underwent enhanced computed tomography （CT） scan of pancreas. Diffused enlargement of pancreas with appearance of sausage was observed in 34 patients and localized pancreatic head enlargement was observed in 9 patients. Twenty patien

关 键 词：自身免疫性胰腺炎 免疫球蛋白G 诊断 治疗 

分 类 号：R576[医药卫生—消化系统]