自身免疫性胰腺炎临床特点分析  

Analysis of the Clinical Feature of Autoimmune Pancreatitis

作　　者：雷鹏[1] 董小英[2] 卜稳平 王根旺[1] 于松宁[1] LEI Peng;DONG Xiaoying;BO Wenping;WANG Genwang;YU Songning(Department of Hepatobiliary Surgery,the General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Endocrinology,the General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院肝胆外科,银川750004 [2]宁夏医科大学总医院内分泌科,银川750004

出　　处：《宁夏医科大学学报》2021年第2期190-194,共5页Journal of Ningxia Medical University

基　　金：宁夏重点研发计划项目(2018BEG03001)。

摘　　要：目的总结自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的临床特点与诊治方法。方法收集27例AIP患者的临床资料,对其临床症状、影像学特点、血清学检查及组织病理学结果进行分析总结。结果27例患者中,22例(81.5%)以梗阻性黄疸为主要临床表现;19例(70.4%)CT检查显示全胰弥漫性肿大,胰腺有明显低密度肿块者8例(29.6%);23例检测IgG4,阳性者19例(82.6%);根据临床症状、影像学表现、血清学及组织病理学确诊17例(63.0%),糖皮质激素诊断性治疗确诊4例(14.9%),6例(22.2%)经手术探查确诊;6例(22.2%)患者术前误诊为胰腺癌或胆管癌,行手术治疗;诊断明确的患者除2例外其余均行受正规的糖皮质激素治疗(口服泼尼松),随访期4~60个月,2例复发,继续激素治疗半年后缓解。结论AIP少见且缺乏特异性的临床表现,误诊率较高,足够重视、充分认识及综合分析临床资料是诊断的关键。Objective To summarize the clinical feature of autoimmune pancreatitis(AIP)and to explore the experience in diagnosis and treatment of this disease.Methods Twenty-seven patients with AIP were analyzed retrospectively,the characters of diagnosis and treatment of AIP were explored through clinical symptoms,imaging features,serologic test results,diagnostic treatment,and histopathologic characteristics.Results Obstructive jaundice was the initial symptom in 22 cases(81.5%).CT showed diffuse enlargement of the pancreas in 19 cases(70.4%),localized pancreatic enlargement in 8 cases(29.6%).IgG4 detection was performed in 23 cases,in whom 19 cases(82.6%)increased.AIP was confirmed by extrapanereatic involvement,radiological and serological results plus biopsy in 17 cases(63.0%),interpretation of response to steroid in 4 cases(14.9%),open laparotomy in 6 cases(22.2%)and misdiagnosed in 6 cases(22.2%).Except for 2 patients,the regular steroid therapy was performed(oral prednisone)and all the patients were cured.The follow-up time range was from 4 to 60 months,2 cases were recurrent followed by the symptoms alleviated after the steroid was applied for half a year.Conclusion AIP is rare and characterized by non-specific clinical manifestations,therefore it is easy to be misdiagnoded.The clinicians should strengthen the recognition of AIP,combining clinical symptoms,radiological features,blood test and histology characteristics together can effectively increase the correct diagnosis rate of AIP.

关 键 词：胰腺炎 自身免疫性 诊断 激素治疗 

分 类 号：R657.51[医药卫生—外科学]