Diagnosis and treatment of autoimmune pancreatitis: experience with 100 patients

查看全文 作　　者：Lei [1]Xin;Yuan-Xiang [2]He;Xiao-Fei [1]Zhu;Qun-Hua [3]Zhang;Liang-Hao [1]Hu;Duo-Wu [1]Zou;Zhen-Dong [1]Jin;Xue-Jiao [4]Chang;Jian-Ming Zheng; Changhai Hospital; Second Military Medical University;Chang-Jing [5]Zuo;Cheng-Wei [6]Shao;Gang [7]Jin;Zhuan [1]Liao;Zhao-Shen [1]Li 机构地区：[1]Department of Gastroenterology, Changhai Hospital, Second Military Medical University;[2]Department of Surgical Oncology, Chinese PLA General Hospital;[3]Department of General Surgery, Huashan Hospital, Fudan University;[4]Department of Pathology,Changhai Hospital, Second Military Medical University;[5]Department of Nuclear Medicine,Changhai Hospital, Second Military Medical University;[6]Department of Radiology , Changhai Hospital, Second Military Medical University;[7]Department of General Surgery, Changhai Hospital, Second Military Medical University 出　　处：《Hepatobiliary & Pancreatic Diseases International》索引2014年第13卷第6期,共7页 基　　金：supported by grants from the National Natural Science Foundation of China (81270541);Disciplinary Joint Research Projects of Changhai Hospital (CH125510312) 摘　　要：BACKGROUND: Autoimmune pancreatitis (AIP) is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China.METHODS: One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients.RESULTS: The median age of the patients at onset was 57 years (range 23-82) with a male to female ratio of 8.1:1. The common manifestations of the patients included obstructive jaundice (49 patients, 49.0%), abdominal pain (30, 30.0%), and acute pancreatitis (11, 11.0%). Biliary involvement was one of the most extrapancreatic manifestations (64, 64.0%). Fifty-six (56.0%) and 43 (43.0%) patients were classified into focaltype and diffuse-type respectively according to the imaging examinations. The levels of serum Ig G and Ig G4 were elevated in 69.4% (43/62) and 92.0% (69/75) patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked (>10 cells/HPF) Ig G4 positive cells were found in 20 (74.1%) patients.Steroid treatment and surgery as the main initial treatments were given to 41 (41.0%) and 28 (28.0%) patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%.CONCLUSIONS: Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP. 关 键 词：急性胰腺炎 自身免疫性 治疗 诊断 实验室检查 临床表现 病理学检查 AIP