Ito Tetsuhide, Kawabe Ken, Arita Yoshiyuki, Hisano Terumasa, Igarashi Hisato, Funakoshi Akihiro, Sumii Toshihiko, Yamanaka Takeharu, Takayanagi Ryoichi
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Pancreas. 2007 Mar;34(2):254-9. doi: 10.1097/01.mpa.0000250127.18908.38.
Up to now, the characteristics of pancreatic endocrine and exocrine functions in autoimmune pancreatitis (AIP) are still unclear. The aim of this study is to evaluate pancreatic functions in AIP compared with those of chronic pancreatitis (CP).
Twelve patients with AIP and 25 patients with CP were examined for exocrine and endocrine pancreas. Exocrine function was evaluated by a secretin test. Concerning endocrine function, insulin secretion (C-peptide response) was examined with the glucagon tolerance test and glucagon secretion was examined with the arginine tolerance test. Pathological examination of pancreatic tissues was done on the operative specimens of AIP and CP that could not be clinically excluded from pancreatic cancer.
For the secretin test, 8.3% of patients with AIP showed 1-factor abnormality, which was a reduction in volume, and 41.7% showed 2-factor abnormalities, which were a reduction in volume and amylase output. On the other hand, 44.0% of patients with CP showed only 1-factor abnormality, which was the reduction in the maximum bicarbonate concentration. Autoimmune pancreatitis accompanied with diabetes mellitus showed a reduction both in DeltaC-peptide response (beta-cell response) and Deltaglucagon (alpha-cell response). Histologically, AIP showed lymphoplasmatic cells infiltration surrounding the pancreatic ducts, but basement membranes were intact. Moreover, basement membranes of the duct were injured in CP. Furthermore, islet cells in AIP were revealed as almost intact even though they were surrounded by fibrosis.
These findings indicate that exocrine dysfunction with AIP is different from CP because AIP induces stenosis of the pancreatic ducts, but ductal cells that possess the function of bicarbonate secretion are intact, and that endocrine dysfunction with AIP was secondary pancreatic diabetes.
迄今为止，自身免疫性胰腺炎（AIP）的胰腺内分泌和外分泌功能特点仍不明确。本研究旨在评估AIP患者与慢性胰腺炎（CP）患者的胰腺功能。
对12例AIP患者和25例CP患者进行胰腺外分泌和内分泌功能检查。通过促胰液素试验评估外分泌功能。关于内分泌功能，采用胰高血糖素耐量试验检测胰岛素分泌（C肽反应），采用精氨酸耐量试验检测胰高血糖素分泌。对临床上无法排除胰腺癌的AIP和CP手术标本进行胰腺组织病理学检查。
促胰液素试验中，8.3%的AIP患者表现为1项指标异常，即容量减少，41.7%的患者表现为2项指标异常，即容量减少和淀粉酶分泌量减少。另一方面，44.0%的CP患者仅表现为1项指标异常，即最大碳酸氢盐浓度降低。合并糖尿病的AIP患者的△C肽反应（β细胞反应）和△胰高血糖素（α细胞反应）均降低。组织学上，AIP表现为胰管周围淋巴细胞和浆细胞浸润，但基底膜完整。此外，CP患者的胰管基底膜受损。此外，AIP患者的胰岛细胞虽被纤维化包围，但几乎完整。
这些发现表明，AIP的外分泌功能障碍与CP不同，因为AIP导致胰管狭窄，但具有碳酸氢盐分泌功能的导管细胞完整，且AIP的内分泌功能障碍为继发性胰腺糖尿病。
