中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 6
Jun.  2021
Turn off MathJax
Article Contents

Clinical features, diagnosis, and treatment of autoimmune pancreatitis

DOI: 10.3969/j.issn.1001-5256.2021.06.054
Research funding:

 (2017-ZJ-936Q);

 ;

 

  • Received Date: 2020-11-30
  • Accepted Date: 2020-12-17
  • Published Date: 2021-06-20
  • Autoimmune pancreatitis (AIP) is an autoimmune-mediated abnormal chronic inflammatory disorder and is often misdiagnosed as pancreatic neoplastic lesions. With in-depth studies of this disease in recent years, it has been taken seriously by hepatobiliary physicians and surgeons. This article summarizes the clinical features, diagnostic criteria, and treatment methods for autoimmune pancreatitis at the present stage, so as to provide clinicians with diagnosis and treatment experience to reduce clinical misdiagnosis.

     

  • loading
  • [1]
    SHIMOSEGAWA T, CHARI ST, FRULLONI L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: Guidelines of the International Association of Pancreatology[J]. Pancreas, 2011, 40(3): 352-358. DOI: 10.1097/MPA.0b013e3182142fd2.
    [2]
    SARLES H, SARLES JC, MURATORE R, et al. Chronic inflammatory sclerosis of the pancreas—an autonomous pancreatic disease?[J]. Am J Dig Dis, 1961, 6: 688-698. DOI: 10.1007/BF02232341.
    [3]
    YOSHIDA K, TOKI F, TAKEUCHI T, et al. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis[J]. Dig Dis Sci, 1995, 40(7): 1561-1568. DOI: 10.1007/BF02285209.
    [4]
    YIN T, WU HS. Progress in diagnosis and treatment of autoimmune pancreatitis[J]. J Clin Hepatol, 2015, 31(5): 665-667. DOI: 10.3969/j.issn.1001-5256.2015.05.006.

    殷涛, 吴河水. 自身免疫性胰腺炎的诊治进展[J]. 临床肝胆病杂志, 2015, 31(5): 665-667. DOI: 10.3969/j.issn.1001-5256.2015.05.006.
    [5]
    ZHAO XD, MA YS, YANG YM. International consensus for the treatment of autoimmune pancreatitis (2016)[J]. J Clin Hepatol, 2017, 33(4): 623-626. DOI: 10.3969/j.issn.1001-5256.2017.04.004.

    赵旭东, 马永蔌, 杨尹默. 2016年国际胰腺病协会共识: 自身免疫性胰腺炎的治疗[J]. 临床肝胆病杂志, 2017, 33(4): 623-626. DOI: 10.3969/j.issn.1001-5256.2017.04.004.
    [6]
    ZHANG DH, ZHAO J. Pathogenesis of immunoglobulin G4-related hepatobiliary and pancreatic diseases[J]. J Clin Hepatol, 2019, 35(6): 1401-1405. DOI: 10.3969/j.issn.1001-5256.2019.06.050.

    张德华, 赵婕. IgG4相关性肝胆胰疾病的发病机制[J]. 临床肝胆病杂志, 2019, 35(6): 1401-1405. DOI: 10.3969/j.issn.1001-5256.2019.06.050.
    [7]
    MASAMUNE A, KIKUTA K, HAMADA S, et al. Nationwide epidemiological survey of autoimmune pancreatitis in Japan in 2016[J]. J Gastroenterol, 2020, 55(4): 462-470. DOI: 10.1007/s00535-019-01658-7.
    [8]
    YANG SF, SUN GM, TIAN FY, et al. The role and significance of surgical intervention in the diagnosis and treatment of autoimmune pancreatitis[J]. Chin J Gen Surg, 2020, 35(2): 112-115. DOI: 10.3760/cma.j.issn.1007-631X.2020.02.007.

    杨士凤, 孙广明, 田凤宇, 等. 外科干预在自身免疫性胰腺炎诊断及治疗中的意义[J]. 中华普通外科杂志, 2020, 35(2): 112-115. DOI: 10.3760/cma.j.issn.1007-631X.2020.02.007.
    [9]
    SUK LEE Y, KIM NH, HYUK SON J, et al. Type 2 autoimmune pancreatitis with Crohn's disease[J]. Intern Med, 2018, 57(20): 2957-2962. DOI: 10.2169/internalmedicine.0213-17.
    [10]
    KAWA S, OKAZAKI K, NOTOHARA K, et al. Autoimmune pancreatitis complicated with inflammatory bowel disease and comparative study of type 1 and type 2 autoimmune pancreatitis[J]. J Gastroenterol, 2015, 50(7): 805-815. DOI: 10.1007/s00535-014-1012-5.
    [11]
    PIOTROWICZ G, STPIEN' B, KLUFCZYN'SKA A. Autoimmune pancreatitis as a component of autoimmune polyglandular syndrome[J]. Prz Gastroenterol, 2017, 12(1): 66-67. DOI: 10.5114/pg.2016.62151.
    [12]
    ZUO S, ZHU HT. Diagnosis and treatment of IgG4-related pancreatitis[J]. Chin J Dig Surg, 2019, 18(12): 1118-1121. DOI: 10.3760/cma.j.issn.1673-9752.2019.12.006.

    左石, 朱海涛. IgG4相关性胰腺炎的诊断与治疗[J]. 中华消化外科杂志, 2019, 18(12): 1118-1121. DOI: 10.3760/cma.j.issn.1673-9752.2019.12.006.
    [13]
    NOTOHARA K, NISHIMORI I, MIZUNO N, et al. Clinicopathological features of type 2 autoimmune pancreatitis in Japan: Results of a multicenter survey[J]. Pancreas, 2015, 44(7): 1072-1077. DOI: 10.1097/MPA.0000000000000438.
    [14]
    NOTOHARA K, KAMISAWA T, FUKUSHIMA N, et al. Guidance for diagnosing autoimmune pancreatitis with biopsy tissues[J]. Pathol Int, 2020, 70(10): 699-711. DOI: 10.1111/pin.12994.
    [15]
    BEYER G, ELLENRIEDER V, NEESSE A. Autoimmune pancreatitis: Avoiding unnecessary procedures by following international consensus guidelines[J]. Digestion, 2015, 92(3): 171-172. DOI: 10.1159/000439249.
    [16]
    XU YB, LIU CZ. Imaging features and diagnostic value of MCST in detecting AIP and pancreatic cancer[J]. Chin J Curr Adv Gen Surg, 2019, 22(8): 615-617, 622. DOI: 10.3969/j.issn.1009-9905.2019.08.007.

    徐英宝, 刘崇忠. MCST检测AIP及胰腺癌的影像学特征及诊断价值分析[J]. 中国现代普通外科进展, 2019, 22(8): 615-617, 622. DOI: 10.3969/j.issn.1009-9905.2019.08.007.
    [17]
    ZHANG YF, OU GC, WANG XM, et al. Transabdominal ultrasound in diagnosing autoimmune pancreatitis[J]. Chin J Ultrasound Med, 2011, 27(12): 1102-1104. DOI: 10.3969/j.issn.1002-0101.2011.12.016.

    张云飞, 欧国成, 王学梅, 等. 自身免疫性胰腺炎的经腹超声表现[J]. 中国超声医学杂志, 2011, 27(12): 1102-1104. DOI: 10.3969/j.issn.1002-0101.2011.12.016.
    [18]
    CHEN ZK, ZHANG XJ, QIAN QF, et al. Ultrasonic features and diagnosis of autoimmune pancreatitis[J]. Chin J Med Imaging Technol, 2019, 35(2): 310-311. DOI: 10.13929/j.1003-3289.201807102.

    陈志奎, 张秀娟, 钱清富, 等. 自身免疫性胰腺炎的超声表现与诊断[J]. 中国医学影像技术, 2019, 35(2): 310-311. DOI: 10.13929/j.1003-3289.201807102.
    [19]
    FRANK G, THOMAS J. Endoscopic ultrasonography[M]. 3rd ed. Wiley Blackwell, 2016: 198-199.
    [20]
    PALAZZO M, PALAZZO L, AUBERT A, et al. Irregular narrowing of the main pancreatic duct in association with a wall thickening is a key sign at endoscopic ultrasonography for the diagnosis of autoimmune pancreatitis[J]. Pancreas, 2015, 44(2): 211-215. DOI: 10.1097/MPA.0000000000000242.
    [21]
    REN S, CUI WJ, CHEN JY, et al. The value of contrast-enhanced CT and MR DWI in differentiating between autoimmune pancreatitis and pancreatic carcinoma[J]. J Pract Radiol, 2018, 34(5): 694-697, 701. DOI: 10.3969/j.issn.1002-1671.2018.05.012.

    任帅, 崔文静, 陈井亚, 等. 增强CT及MR DWI序列对自身免疫性胰腺炎与胰腺癌的鉴别诊断价值[J]. 实用放射学杂志, 2018, 34(5): 694-697, 701. DOI: 10.3969/j.issn.1002-1671.2018.05.012.
    [22]
    HE M, WU AL, HAN P, et al. Imaging differentiation of autoimmune pancreatitis from pancreatic carcinoma[J]. Radiol Pract, 2017, 32(6): 598-601. DOI: 10.13609/j.cnki.1000-0313.2017.06.012.

    何铭, 吴爱兰, 韩萍, 等. 自身免疫性胰腺炎与胰腺癌的鉴别诊断[J]. 放射学实践, 2017, 32(6): 598-601. DOI: 10.13609/j.cnki.1000-0313.2017.06.012.
    [23]
    SU YW, LI J, ZHANG X. Imaging findings and diagnostic value of CT and MRI for autoimmune pancreatitis[J]. J Log Univ CAPF (Med Sci), 2016, 25(11): 886-888. https://www.cnki.com.cn/Article/CJFDTOTAL-WUXB201611006.htm

    苏亚文, 李敬, 张旭. 自身免疫性胰腺炎CT、MRI表现及诊断[J]. 武警后勤学院学报(医学版), 2016, 25(11): 886-888. https://www.cnki.com.cn/Article/CJFDTOTAL-WUXB201611006.htm
    [24]
    ZHANG BB, ZHANG J, JIN EH, et al. CT features and follow-up analysis of autoimmune pancreatitis[J]. Computerized Tomography Theory and Applications, 2015, 24(3): 421-428. DOI: 10.15953/j.1004-4140.2015.24.03.12.

    张斌斌, 张洁, 靳二虎, 等. 自身免疫性胰腺炎CT表现及随访分析[J]. CT理论与应用研究, 2015, 24(3): 421-428. DOI: 10.15953/j.1004-4140.2015.24.03.12.
    [25]
    LIU L, ZHANG J, JIA GR, et al. Imaging characteristics of autoimmune pancreatitis: 18F-FDG PET/CT versus contrast enhanced CT[J]. Chin J Pancreatol, 2015, 15 (6): 379-384. DOI: 10.3760/cma.j.issn.1674-1935.2015.06.005.

    刘莉, 张建, 贾国荣, 等. 18F-FDG PET/CT与增强CT对自身免疫性胰腺炎影像特征显示效能的对照研究[J]. 中华胰腺病杂志, 2015, 15(6): 379-384. DOI: 10.3760/cma.j.issn.1674-1935.2015.06.005.
    [26]
    ZHANG J, SHAO C, WANG J, et al. Autoimmune pancreatitis: Whole-body 18F-FDG PET/CT findings[J]. Abdom Imaging, 2013, 38(3): 543-549. DOI: 10.1007/s00261-012-9966-3.
    [27]
    van HEERDE MJ, BUIJS J, HANSEN BE, et al. Serum level of Ca 19-9 increases ability of IgG4 test to distinguish patients with autoimmune pancreatitis from those with pancreatic carcinoma[J]. Dig Dis Sci, 2014, 59(6): 1322-1329. DOI: 10.1007/s10620-013-3004-3.
    [28]
    MINAGA K, WATANABE T, HARA A, et al. Identification of serum IFN-α and IL-33 as novel biomarkers for type 1 autoimmune pancreatitis and IgG4-related disease[J]. Sci Rep, 2020, 10(1): 14879. DOI: 10.1038/s41598-020-71848-4.
    [29]
    SUZUKI D, SHIMIZU K, TOKUSHIGE K. Relative rise of serum IgG4 levels after steroid therapy for autoimmune pancreatitis predicts the likelihood of relapse[J]. Pancreas, 2018, 47(4): 412-417. DOI: 10.1097/MPA.0000000000001007.
    [30]
    QIAN JM, LAI YM. Research history and perspectives of autoimmune pancreatitis[J]. J Clin Hepatol, 2018, 34(8): 1595-1598. DOI: 10.3969/j.issn.1001-5256.2018.08.001.

    钱家鸣, 赖雅敏. 自身免疫性胰腺炎的研究历程与展望[J]. 临床肝胆病杂志, 2018, 34(8): 1595-1598. DOI: 10.3969/j.issn.1001-5256.2018.08.001.
    [31]
    DITE P, NOVOTNY I, DVORACKOVA J, et al. Pancreatic solid focal lesions: Differential diagnosis between autoimmune pancreatitis and pancreatic cancer[J]. Dig Dis, 2019, 37(5): 416-421. DOI: 10.1159/000499762.
    [32]
    BLAHO M, DÍTEˇ P, KUNOVSKY L, et al. Autoimmune pancreatitis-An ongoing challenge[J]. Adv Med Sci, 2020, 65(2): 403-408. DOI: 10.1016/j.advms.2020.07.002.
    [33]
    LIAO D. Analysis of 3 cases of autoimmune pancreatitis that are easily misdiagnosed as pancreatic cancer and related literature review[D]. Nanjing: Nanjing Medical University, 2019.

    廖丹. 易被误诊为胰腺癌的自身免疫性胰腺炎3例临床分析及相关文献复习[D]. 南京: 南京医科大学, 2019.
    [34]
    CHENG J. Management strategy and prognosis of patients with intraductal papillary mucinous neoplasms of the pancreas[D]. Hangzhou: Zhejiang University, 2019.

    成君. 胰腺导管内乳头状黏液性肿瘤的诊治和预后分析[D]. 杭州: 浙江大学, 2019.
    [35]
    SAFI F, SCHLOSSER W, FALKENRECK S, et al. Prognostic value of CA 19-9 serum course in pancreatic cancer[J]. Hepatogastroenterology, 1998, 45(19): 253-259. http://gut.bmj.com/external-ref?access_num=9496523&link_type=MED
    [36]
    ZENG N, HUANG ZX, SONG B. Current status of intraductal papillary mucinous neoplasms of pancreas in imaging[J]. Chin J Bases and Clin Gen Surg, 2020, 27(3): 353-357. DOI: 10.7507/1007-9424.202001009.

    曾妮, 黄子星, 宋彬. 胰腺导管内乳头状黏液肿瘤的影像学研究现状及进展[J]. 中国普外基础与临床杂志, 2020, 27(3): 353-357. DOI: 10.7507/1007-9424.202001009.
    [37]
    OKAZAKI K, CHARI ST, FRULLONI L, et al. International consensus for the treatment of autoimmune pancreatitis[J]. Pancreatology, 2017, 17(1): 1-6. DOI: 10.1016/j.pan.2016.12.003.
    [38]
    KAMISAWA T, OKAZAKI K, KAWA S, et al. Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 Ⅲ. Treatment and prognosis of autoimmune pancreatitis[J]. J Gastroenterol, 2014, 49(6): 961-970. DOI: 10.1007/s00535-014-0945-z.
    [39]
    SELEZNIK G, GRAF R. Alternatives to steroids?! Beneficial effects of immunosuppressant drugs in autoimmune pancreatitis[J]. Gut, 2014, 63(3): 376-377. DOI: 10.1136/gutjnl-2013-304768.
    [40]
    de PRETIS N, AMODIO A, BERNARDONI L, et al. Azathioprine maintenance therapy to prevent relapses in autoimmune pancreatitis[J]. Clin Transl Gastroenterol, 2017, 8(4): e90. DOI: 10.1038/ctg.2017.17.
    [41]
    ROVATI L, LANZILLOTTA M, BOZZOLO E, et al. Methotrexate as induction of remission therapy for type 1 autoimmune pancreatitis[J]. Am J Gastroenterol, 2019, 114(5): 831-833. DOI: 10.14309/ajg.0000000000000232.
    [42]
    HART PA, TOPAZIAN MD, WITZIG TE, et al. Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: The Mayo Clinic experience[J]. Gut, 2013, 62(11): 1607-1615. DOI: 10.1136/gutjnl-2012-302886.
    [43]
    LIN XC, HUANG HG, CHEN YC, et al. Diagnosis and treatment of autoimmune pancreatitis and the value of surgery[J]. Chin J Pract Surg, 2019, 39(3): 255-259. DOI: 10.19538/j.cjps.issn1005-2208.2019.03.17.

    林贤超, 黄鹤光, 陈燕昌, 等. 自身免疫性胰腺炎的诊治及外科手术价值研究[J]. 中国实用外科杂志, 2019, 39(3): 255-259. DOI: 10.19538/j.cjps.issn1005-2208.2019.03.17.
    [44]
    BI Y, HART PA, LAW R, et al. Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting[J]. Pancreatology, 2016, 16(3): 391-396. DOI: 10.1016/j.pan.2016.03.017.
    [45]
    KURAISHI Y, MURAKI T, ASHIHARA N, et al. Validity and safety of endoscopic biliary stenting for biliary stricture associated with IgG4-related pancreatobiliary disease during steroid therapy[J]. Endosc Int Open, 2019, 7(11): e1410-e1418. DOI: 10.1055/a-0966-8494.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (754) PDF downloads(195) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return