Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 113-8677 Tokyo, Japan.
Scand J Gastroenterol. 2004 Nov;39(11):1154-8. doi: 10.1080/00365520410008033.
Although many patients with autoimmune pancreatitis undergo steroid therapy, detailed evaluation of morphological changes in the pancreas and bile duct following therapy has not been performed in this disease. In this study serological and morphological changes occurring during steroid treatment of autoimmune pancreatitis are comparatively examined.
Ten patients with autoimmune pancreatitis were treated with corticosteroids. Morphological findings were: pancreatic enlargement (n = 9), irregular narrowing of the main pancreatic duct (n = 10), and biliary stenosis (n = 9). An initial dose of prednisolone was 40-30 mg/day, and this was tapered by 5 mg every 1-2 weeks. All patients underwent ultrasound and serological testing 1-2 weeks after commencing medication, followed by weekly serological testing and by CT and endoscopic retrograde cholangiopancreatography after 1-2 months. Radiological and serological changes were compared.
All 10 patients were responsive to steroid therapy. Pancreatic size normalized within 1 month; however, irregularity of the pancreatic duct remained in 6 patients. Rigidity or lateral deformity of the bile duct remained in 3 patients and biliary stenosis persisted in 5. Four patients in whom elevated serum IgG4 failed to normalize also showed incomplete morphological improvement. Three patients with complete improvement of the pancreatic duct stopped medication, but recurrence of pancreatitis did not occur.
Although steroid therapy was morphologically and serologically effective in patients with autoimmune pancreatitis, cholangiopancreatographic abnormalities remained in many patients. Morphological improvement on cholangiopancreatography and normalization of serum IgG4 after steroid therapy appeared to be good indicators for discontinuing medication in patients with autoimmune pancreatitis.
尽管许多自身免疫性胰腺炎患者接受了类固醇治疗，但尚未对该病治疗后胰腺和胆管的形态学变化进行详细评估。在本研究中，对自身免疫性胰腺炎类固醇治疗期间发生的血清学和形态学变化进行了比较研究。
10例自身免疫性胰腺炎患者接受了皮质类固醇治疗。形态学表现为：胰腺肿大（9例）、主胰管不规则狭窄（10例）和胆管狭窄（9例）。泼尼松龙初始剂量为40 - 30mg/天，每1 - 2周减量5mg。所有患者在开始用药后1 - 2周接受超声和血清学检测，随后每周进行血清学检测，并在1 - 2个月后进行CT和内镜逆行胰胆管造影。比较放射学和血清学变化。
所有10例患者对类固醇治疗均有反应。胰腺大小在1个月内恢复正常；然而，6例患者胰管仍不规则。3例患者胆管僵硬或出现侧方畸形，5例患者胆管狭窄持续存在。4例血清IgG4升高未恢复正常的患者形态学改善也不完全。3例胰管完全改善的患者停药，但未发生胰腺炎复发。
尽管类固醇治疗对自身免疫性胰腺炎患者在形态学和血清学方面有效，但许多患者胰胆管造影异常仍存在。类固醇治疗后胰胆管造影形态学改善和血清IgG4恢复正常似乎是自身免疫性胰腺炎患者停药的良好指标。
