Clinical features of type 1 autoimmune pancreatitis: an analysis of 13 cases
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摘要:
目的总结1型自身免疫性胰腺炎(AIP)的临床特征,进一步认识该病,减少误诊率,加深人们对该病的认识。方法回顾性分析2012年1月-2016年12月吉林大学第一医院收治的13例1型AIP患者的临床资料,包括一般情况、临床表现、实验室血清学检查、影像学、组织病理学、治疗及预后等。结果 13例患者中男9例,女4例,平均(60.08±9.47)岁。主要临床表现为黄疸(69.2%)、腹痛(61.5%)、体质量减轻(61.5%);最常见合并累及器官为胆管受累(46.2%)、硬化性胆管炎(30.8%);23.1%患者合并糖尿病;血清学指标中92.30%患者Ig G4升高2倍以上,7.69%升高12倍,53.85%患者CA19-9升高,69.23%患者TBil升高,三分之二以上患者转氨酶或GGT升高;影像学表现上53.8%患者CT示胰腺弥漫性肿大,46.2%为局灶性肿大,46.2%胰腺病变区低密度包囊样边缘影;病理检查显示胰腺导管周围纤维结缔组织增生,伴大量淋巴细胞、浆细胞浸润。所有患者均接受正规的糖皮质激素治疗(起始剂量泼尼松3040 mg/d),激素治疗...
Abstract:Objective To investigate the clinical features of type 1 autoimmune pancreatitis ( AIP) , and to deepen the understanding of this disease, reduce false positive rate, and enhance people' s awareness of this disease. Methods A retrospective analysis was performed for the clinical data of 13 patients with type 1 AIP who were admitted to The First Hospital of Jilin University from January 2012 to December 2016, including general status, clinical manifestations, laboratory serological examination, imaging findings, histopathological findings, treatment, and prognosis. Results Of all 13 patients, there were 9 male and 4 female patients with a mean age of 60. 08 ± 9. 47 years. Major clinical manifestations included jaundice ( 69. 2%) , abdominal pain ( 61. 5%) , and weight loss ( 61. 5%) . The most common organ involved was bile duct ( 46. 2%) , and 30. 8% of the patients had sclerosing cholangitis. Of all patients, 23. 1% had diabetes. As for serological markers, 92. 30% patients had more than 2 times increase in Ig G4, and 7. 69% had 1-2 times increase in Ig G4; 53. 85% patients had an increase in CA19-9; 69. 23% patients had an increase in total bilirubin; more than two thirds of the patients had an increase in aminotransferases or gamma-glutamyl transpeptidase. As for imaging findings, 53. 8% patients had diffuse enlargement of the pancreas on CT, 46. 2% had focal enlargement of the pancreas, and 46. 2% patients had low-density cyst-like shadow in pancreatic lesions. Pathological examination showed fibrous connective tissue proliferation with infiltration of lymphocytes and plasma cells. All patients were given standard glucocorticoid therapy ( initial dose of prednisone: 30-40 mg/d) and the remission rate of glucocorticoid therapy was 100%. The follow-up time was 12 months, and one patient experienced multiple recurrences in the course of the disease. Conclusion Type 1 AIP is the local manifestation of Ig G4-associated disease in the pancreas, which often occurs in middle-aged and elderly men, and most patients are complicated by extrapancreatic lesions. Glucocorticoid therapy is effective and most patients have good prognosis. Recurrence often occurs in the case of no standard or long-term glucocorticoid therapy.
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Key words:
- pancreatitis /
- immunoglobulin G /
- glucocorticoids
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