自身免疫性胰腺炎37例临床特点及误诊原因分析  

Clinical Features and Misdiagnosed Causes of 37 Patients with Autoimmune Pancreatitis

作　　者：王天龙[1] 张齐[1] 王雅玮[1] 吴刚[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

出　　处：《临床误诊误治》2017年第10期50-54,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的临床特点、鉴别诊断要点及误诊原因,以提高临床医生对其的认识程度,避免误诊误治。方法对2010年2月—2016年10月中国医科大学附属第一医院收治的37例AIP患者(9例误诊)的临床资料进行回顾性分析。结果 37例多表现为进行性皮肤、巩膜黄染伴上腹部不适,影像学表现为胰腺弥漫性增大伴胰管弥漫性不规则狭窄30例,胰头局灶性增大伴胰头处胰管狭窄7例,均有胆总管胰腺段狭窄。13例患胰腺外自身免疫性疾病,20例胰腺外器官受累。24例接受Ig G(Ig G4、γ-球蛋白)和自身免疫性抗体检测,其中20例Ig G(Ig G4、γ-球蛋白)升高,11例自身免疫性抗体阳性。10例胰腺外病变病理免疫组织化学染色(免疫组化)示有大量淋巴细胞和Ig G4阳性浆细胞浸润。28例行皮质类固醇激素治疗,6例复发,继续激素治疗后治愈。9例(24.3%)误诊为胰腺癌行手术治疗,其中8例行胆管空肠吻合术、1例行胰十二指肠切除术,结合术后病理及胰腺影像学检查结果确诊为AIP,随访两年无复发。结论 AIP与胰腺癌临床表现相似易误诊,及时完善血清免疫学指标检测、必要时行试验性激素治疗,有助于二者鉴别。Objective To investigate clinical features, differential diagnosis and misdiagnosed causes of autoimmune pancreatitis （ AIP） in order to improve the clinician ＆#39;s understanding and avoid misdiagnosis and mistreatment. Methods Clinical data of 37 AIP patients admitted between February 2010 and October 2016 was retrospectively analyzed. Results The main manifestations of 37 patients （9 misdiagnosed patients） were progressive skin or sclera icterus accompanied by upper abdomen discomfort. Imaging showed that 30 patients had diffuse enlargement of pancreas and diffuse irregular narrowing of pancreatic duct, and 7 patients had focal caput pancreatis enlargement accompanied by narrowing of pancreatic duct in caput pancreatis. Stenosis of common bile duct located in pancreas was found in all patients. There were 13 patients with other auto-immune diseases besides AIP and 20 patients with other organs involvement besides pancreas. Serum immunoglobulin G （ IgG4 orγ-globulin） and autoimmunity antibody detections were performed for 24 patients, in whom20 patients had increased expres-sion of serumIgG4 or γ-globulin, and 11 patients had positive autoimmune antibodies. Pathology and immunohistochemistry tests for 10 patients with other organ lesions showed massive lymphocytes and IgG4 （ ＋） plasmacytes infiltration. Corticoste-roid hormone treatment was performed for 28 patients, in whom 6 patients recurred and were cured after continuous hormone therapy. Surgery treatment was performed for 9 patients （24. 3%） misdiagnosed as having pancreatic cancer, in whom 8 pa-tients underwent cholangiojejunostomy and 1 patient underwent pancreatoduodenectomy, and then AIP was confirmed on the basis of results of postoperative pathology and imaging of pancreas, and there was no recurrence during 2 years of follow-up. Conclusion Clinical features of AIP is similar to those of pancreatic cancer, and therefore it is easy to be misdiagnosed. It is helpful to distinguish AIP from pancreatic cancer by performing seru

关 键 词：胰腺炎 自身免疫疾病 误诊 胰腺肿瘤 

分 类 号：R576[医药卫生—消化系统]